- Abstract: This paper discusses how law is
increasingly being used to attack religious associations under the guise
of "equality" advancement and "non-discrimination" restrictions. I
explore two important insights: first that the concept of
"transformation" has been distorted, to shelter approaches to law that
fail to respect properly associational diversity. When misused,
"transformation" seeks to change the moral viewpoints or religious
beliefs of religious associations by force of law. Second, the paper
discusses the expansion of law so that it becomes a threat to
associations. The "goods of religion" and the "limits of law" need to be
more widely recognized and understood both by religious communities and
by those involved in law, politics and the media. These insights
demonstrate how "equality activists" employ a rhetoric of "equality" to
produce inequality, "diversity" to produce homogeneity and
"non-discrimination" to discriminate against religious communities and
religious beliefs. Several solutions for identifying these errors and
resisting them are outlined in brief.[
- Abstract: Issues arising from the death of Savita
Halappanavar in Ireland in October 2012 include the question of whether
it is unethical to refuse to terminate a non-viable pregnancy when the
woman's life may be at risk. In Catholic maternity services, this
decision intersects with health professionals' interpretation of
Catholic health policy on treatment of miscarriage as well as the law on
abortion. This paper explores how these issues came together around
Savita's death and the consequences for pregnant women and maternity
services worldwide. It discusses cases not only in Ireland but also the
Americas. Many of the events presented are recent, and most of the
sources are media and individual reports. However, there is a very
worrying common thread across countries and continents. If further
research unearths more cases like Savita's, any Catholic health
professionals and/or hospitals refusing to terminate a pregnancy as
emergency obstetric care should be stripped of their right to provide
services. In some countries these are the main or only
existing maternity services. Even so, governments should refuse to fund
these services, and either replace them with non-religious services or
require that non-religious staff are available at all times specifically
to take charge of such cases to prevent unnecessary deaths. At issue is
whether a woman's life comes first or not at all.
- Abstract: Pharmacists who refuse to provide certain
services or treatment for reasons of conscience have been criticized for
failing to fulfil their professional obligations. Currently, individual
pharmacists in Great Britain can withhold services or treatment for
moral or religious reasons, provided they refer the patient to an
alternative source. The most high-profile cases have concerned the
refusal to supply emergency hormonal contraception, which will serve as
an example in this article.
I propose that the pharmacy profession's policy on
conscientious objections should be altered slightly. Building on the work of
Brock and Wicclair, I argue that conscientious refusals should be acceptable
provided that the patient is informed of the service, the patient is
redirected to an alternative source, the refusal does not cause an
unreasonable burden to the patient, and the reasons for the refusal are
based on the core values of the profession. Finally, I argue that a
principled categorical refusal by an individual pharmacist is not morally
permissible. I claim that, contrary to current practice, a pharmacist cannot
legitimately claim universal exemption from providing a standard service,
even if that service is available elsewhere.
- Healthcare personnel may perceive troubled conscience when feeling
inadequate and powerless. It is important to further explore healthcare
personnel's descriptions of situations in daily work, which generate
troubled conscience to increase the awareness of such situations. This
study aimed to describe health care personnel's experiences of
situations in municipal elderly care that generate troubled conscience.
In this qualitative study, interviews were conducted with Registered and
Enrolled nurses and nursing assistants (n = 20) working in municipal
elderly care. . .
- The conception of conscience that dominates discussions in bioethics
focuses narrowly on private regulation of behaviour resulting from
explicit attitudes. It neglects to mention implicit attitudes and the
role of social feedback in becoming aware of one's implicit attitudes.
But if conscience is a way of ensuring that a person's behaviour is in
line with her moral values, it must be responsive to all aspects of the
mind that influence behaviour. There is a wealth of recent psychological
work demonstrating the influence of implicit attitudes on behaviour. A
necessary part of having a well-functioning conscience must thus be
awareness and regulation of one's implicit attitudes in addition to
one's explicit attitudes; this cannot be done by an individual in
isolation. On my revised conception of conscience, heeding social
feedback, being emotionally self-aware and engaging in self-monitoring
are important for the possession of a well-functioning conscience.
Health professionals may need specific training to help them develop and
maintain a well-functioning conscience, which should involve cultivation
of awareness of implicit attitudes, emphasis on social feedback and
techniques to enable better control over them.
- It appears, at times, that health care and religion do not mix.
Consider the sterilization and contraception coverage mandate under the
Patient Protection and Affordable Care Act. The mandate requires nearly
all employers and health insurers to cover as "essential health care
services" certain sterilization procedures and contraceptives, including
emergency contraceptives. Members of the Catholic, evangelical
Christian, Mennonite, and Muslim faith communities say that the mandate
places them "in the untenable position of having to choose between
violating the law and violating their consciences." . . .
Much research is currently being conducted on health care
practitioners' experiences of moral distress, especially the
experience of nurses. What moral distress is, however, is not always
clearly delineated and there is some debate as to how it should be
defined. This article aims to help to clarify moral distress. My
methodology consists primarily of a conceptual analysis, with
especial focus on Andrew Jameton's influential description of moral
I will identify and aim to resolve two sources of confusion about
moral distress: (1) the compound nature of a narrow definition of
distress which stipulates a particular cause, i.e. moral constraint,
and (2) the distinction drawn between moral dilemma (or, more
accurately, moral conflict) and moral distress, which implies that
the two are mutually exclusive.
In light of these concerns, I argue that the definition of moral
distress should be revised so that moral constraint should not be a
necessary condition of moral distress, and that moral conflict
should be included as a potential cause of distress. Ultimately, I
claim that moral distress should be understood as a specific
psychological response to morally challenging situations such as
those of moral constraint or moral conflict, or both.
- Abstract: Emergency hormonal contraception
(EHC) has been available from pharmacies in the UK without prescription
for 11 years. In the Republic of Ireland this service was made available
in 2011. In both jurisdictions the respective regulators have included
conscience clauses which allow pharmacists to opt out of providing
EHC on religious or moral grounds providing certain criteria are met. In
effect, conscientious objectors must refer patients to other providers
who are willing to supply these medicines. Inclusion of such clauses
leads to a cycle of cognitive dissonance on behalf of both parties.
Objectors convince themselves of the existence of a
moral difference between supply of EHC and referral to another supplier,
while the regulators must feign satisfaction that a form of regulation
lacking universality will not lead to adverse consequences in the long term.
We contend that whichever of these two parties truly believes in that which
they purport to must act to end this unsatisfactory status quo. Either the
regulators must compel all pharmacists to dispense emergency contraception
to all suitable patients who request it, or a pharmacist must refuse either
to supply EHC or to refer the patient to an alternative supplier and
challenge any subsequent sanctions imposed by their regulator.
- The exercise of conscience in health care is generally considered
synonymous with refusal to participate in contested medical services,
especially abortion. This depiction neglects the fact that the provision
of abortion care is also conscience-based. The persistent failure to
recognize abortion provision as â€œconscientiousâ€ has resulted in
laws that do not protect caregivers who are compelled by conscience to
provide abortion services, contributes to the ongoing stigmatization of
abortion providers, and leaves theoretical and practical blind spots in
bioethics with respect to positive claims of conscience â€” that is,
conscience-based claims for offering care, rather than for refusing to
Heino A, Gissler M, Apter D, Fiala C.
Conscientious objection and induced abortion in Europe. The
European Journal of Contraception and Reproductive Health Care, 2013; 18:
- Abstract: The issue of conscientious objection (CO)
arises in healthcare when doctors and nurses refuse to have any
involvement in the provision of treatment of certain patients due to
their religious or moral beliefs. Most commonly CO is invoked when it
comes to induced abortion. Of the EU member states where induced
abortion is legal, invoking CO is granted by law in 21 countries. The
same applies to the non-EU countries Norway and Switzerland. CO is not
legally granted in the EU member states Sweden, Finland, Bulgaria and
the Czech Republic. The Icelandic legislation provides no right to CO
either. European examples prove that the recommendation that CO should
not prevent women from accessing services fails in a number of cases. CO
puts women in an unequal position depending on their place of residence,
socio-economic status and income. CO should not be presented as a
question that relates only to health professionals and their rights. CO
mainly concerns women as it has very real consequences for their
reproductive health and rights. European countries should assess the
laws governing CO and its effects on women ' s rights. CO should not be
used as a subtle method for limiting the legal right to healthcare.
- Introduction: In 1853 Herman Melville published
"Bartleby, the Scrivener," his now most well-known piece of short
fiction, which over a century and a half later we can certainly read as
an illuminating dramatization of conscientious objection . There are,
of course, important differences between Melville's approach to refusal
and how we have come to discuss it in medical ethics. The story's
setting, for instance, is not clinical; the central exchanges are
between the head of a law office and an employee who politely but
insistently refuses to carry out his understood duties.
Conscience, values, and justice in Savulescu. Virtual Mentor. 2013 Mar
1;15(3):208-12. doi: 10.1001/virtualmentor.2013.15.3.jdsc1-1303. PubMed
Savulescu's 2006 article in the British Medical Journal takes up perennially unfinished work on the nature and place of conscience, carried out against the background of contested laws shaped by states and their institutions as well as peoples and their professions. His writing on conscientious objection essentially returns to and intervenes in an extended conversation made possible by continued shifts in relations between individual citizens and loci of authority; shifts that characterized the mid-to-late decades of the twentieth century, when debates about war, civil rights, reproduction, and capital punishment made objection a vital mode of participation and engendered fields of practice and scholarship organized around the mission to decentralize decision making.
- 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.
- Abstract: Brain death or neurologic death
has gradually become recognized as human death over the past decades
worldwide. Nevertheless, in Japan, the New York State, and the State of New
Jersey, one can be exempt from death determination based on neurologic
criteria even in the state of brain death. In Japan, the 1997 Act on Organ
Transplantation legalized brain death determination exclusively when organs
were to be procured from brain-dead patients. Even after the 2009 revision,
the default definition of death continued to be cardio-pulmonary criteria,
despite the criticism.
The cases of Japan and the United States provide a good
reference as social experiments of appreciating conscientious or
religio-cultural dimensions in health care. This text theoretically examines
the 1997 Act on Organ Transplantation of Japan and its 2009 revision,
presenting some characteristics of Japan's case compared to American cases
and the implications its approach has for the rest of the world. This is an
example in which a foreign idea that did not receive widespread support from
Japanese citizens was transformed to fit the religio-cultural landscape.
Brain death (neurologic death) has gradually been recognized
as human death over the past decades worldwide. Nevertheless, in Japan, the
New York State, and the State of New Jersey, one can be exempt from death
determination based on neurologic criteria even in the case of brain death.
The New York State established the Guidelines for the Determination of Brain
Death (1987, 1995, 2005) to accommodate religious or moral objections to
brain death. The State of New Jersey also enacted the Declaration of Death
Act (1991) to accommodate religious objections to brain death. All this
resulted from the accommodation of religious and moral objections to
Hans-Martin Sass argued for "a formula for a global Uniform
Determination of Death statute, based on the 'entire brain including brain
stem' criteria as a default position, but allowing competent adults by means
of advance directives to choose other criteria for determining death during
the process of dying." These cases provide a good reference as social
experiments in order to evaluate this formula.
In the text, the term "conscience" or its adjective form is
chosen as a superordinate concept to moral/religious belief according to
conventional usage. Conscience might appear universal whereas
religio-cultural dimension differs among nations. In this text, conscience
is considered to manifest itself within different societal traditions.
- The degree to which "conscience" should guide physician practice has
been frequently debated in recent years within medicine, bioethics, and
health policy circles [1-3] and has found new life in the debate about
various "conscience protection" rules issued by the G. W. Bush and Obama
presidential administrations. In these debates, physician "conscience"
has been invoked in the medical literature almost exclusively in cases
in which physicians attempt to avoid or to decline participation in
practices or procedures that they find morally objectionable, often
because such practices violate the physician's religious or cultural
practices. In this debate, "conscience" is therefore often associated
with religious belief or, at least, with deeply held "values" of the
physician in question. . .
examination of conscience. Virtual Mentor. 2013 Mar 1;15(3):185-7. doi:
10.1001/virtualmentor.2013.15.3.fred1-1303. PubMed PMID: 23472804.
- "There seems to be no rational way of securing moral agreement in our culture," mourns Alasdair MacIntyre in the second edition of After Virtue . In place of a common dialogue, we find a fragmented morality made up of individual commitments - commitments whose incommensurability lends, he argues, to the "shrill tone of so much moral debate." MacIntyre continues, "The rival premises are such that we possess no rational way of weighing the claims of one as against the other."
. . .
- Conscientious refusal is distinguished by its peculiar attitude
towards the obligations that the objector refuses: the objector accepts
the authority of the institution in general, but claims a right of
conscience to refuse some particular directive. An adequate ethics of
conscientious objection will, then, require an account of the
institutional obligations that the objector claims a right to refuse.
Yet such an account must avoid two extremes: â€˜anarchism,â€™ where
obligations apply only insofar as they match individual conscience; and
â€˜totalitarianism,â€™ where even immoral obligations bind us. The challenge
is to explain institutional obligations in such a way that an agent can
be obligated to act against conscience, yet can object if the
institution's orders go too far. Standard accounts of institutional
obligations rely on individual autonomy, expressed through consent. This
paper rejects the Consent model; a better understanding of institutional
obligations emerges from reflecting on the intersecting goods produced
by institutions and the intersecting autonomy of numerous distinct
agents rather than only one. The paper defends 'Professionalism'
as a grounding of professional obligations. The professional context can
justify acting against conscience but more often that context partly
shapes the professional conscience. Yet Professionalism avoids
totalitarianism by distinguishing between (mere) injustice and abuse.
When institutions are â€“ or we conscientiously believe them to be â€“
merely unjust, their directives still obligate us; when they are
abusive, however, they do not. Finally, the paper applies these results
to the problem of conscientious refusal in general and specifically to
controversial reproduction cases.
- Abstract: Background: Despite restrictive abortion
law in Nigeria, women still seek abortion services. Restrictive policies
on abortion make it difficult for safe and legal abortion to be
obtained. Hence, abortion is provided on clandestine basis in some
private health facilities, and where the cost of such service is
prohibitory, women resort to unsafe methods, including visiting quacks
and self medication, resulting in severe complications including death.
In Nigeria, little is known about the personal and professional
attitudes of individuals who are currently providing abortion services.
Exploring the factors which determine health care providers' involvement
in or disengagement from abortion services may facilitate improvement in
the planning and provision of future services.
Methods: Data were collected using qualitative
research methods. Thirty-six in-depth interviews and one focus group
discussion were conducted between January 2010 and July 2010 with health
care providers who were involved in a range of abortion services provision
in the Western Nigeria. Data were analysed using a thematic analysis
Results: Complex patterns of service delivery were
prevalent throughout many of the health care facilities. Fragmented levels
of service provision operated in order to accommodate health care providers'
willingness to be involved in different aspects of abortion provision.
Closely linked with this was the urgent need expressed by many providers for
liberalization of abortion laws in Nigeria in order to create a supportive
environment for both clients and providers. Almost all providers were
concerned about the numerous difficulties women faced in seeking an
abortion and their general quality of care. An overriding concern was poor
pre and post abortion counselling including contraceptive counselling and
Conclusion: This is the first known qualitative study
undertaken in Nigeria exploring providers' attitudes towards abortion and it
adds to the body of information addressing the barriers to safe abortion
services. In order to provide an enabling environment and sustain a pool of
abortion service providers, a drastic change in Nigerian abortion laws is
mandatory, after which policies that both attract prospective abortion
service providers and retain existing ones can be developed.
Conscientious Refusals and Reason-Giving. Bioethics. 2013 Feb 28. doi:
10.1111/bioe.12012. [Epub ahead of print] PubMed PMID: 23445457.
- Abstract: 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.
- Abstract: The article presents information on a
proliferation in conscience clause legislation to federal and state laws
in the U.S. The move is stated to be pitting individual religious
autonomy against the public interest, mainly in the areas of education and
health care. Right of refusal laws is closely related to abortion
conscience clauses are pharmacist.
- I read Robert Cardâ€™s recent paper entitled 'Is there no alternative?
Conscientious objection by medical students' with great interest. That
Muslim students in America are able to conscientiously object (and this was
entertained) to the cross-gender consultation is somewhat startling. I have
just left the Middle East, where I worked as a medical educator for
five-and-a-half years (2006â€“2011), and, to the best of my knowledge, even in
the conservative, gender-segregated traditional Muslim culture of the United
Arab Emirates, not once did a male or female student refuse to examine a
patient of the opposite sex. . .
- Abstract: What is a health care provider to do when
they find that their moral integrity is at odds with professional
expectations? Should a nurse with religious objections to assisted
reproduction be asked to stop working in obstetrics and gynecology? Can
a pharmacist with moral objections to emergency contraception refer a
patient to a colleague without being complicit in a perceived moral
wrong doing? Should religious organizations be required to provide or
pay for objectionable health services? When is a patient's health and
well-being more important than a professional's moral integrity? Here
we: 1) describe a collaboration between a medical librarian and the
Indiana University (IU) Conscience Project 2) outline the subject of
conscientious objection in the healing professions, and 3) introduce a
new readers' guide on the topic.
conscience, and professional obligation. Virtual Mentor. 2013 Mar
1;15(3):244-8. doi: 10.1001/virtualmentor.2013.15.3.msoc1-1303. PubMed PMID:
care professionals have a fiduciary relationship with their patients;
i.e., because they have greater knowledge and authority than their
patients, they have an obligation to be trustworthy and to serve
patients' best interests. This has been taught since the era of
Hippocrates and continues in contemporary medicine, as stated, for
example, in the American Medical Association's Principles of Medical
Ethics. . .
- Corporations â€” for-profit and non-profit, religiously affiliated and
secular â€” have filed approximately sixty lawsuits challenging the
Affordable Care Actâ€™s requirement that employee health insurance plans
cover contraception. In this paper, I contend that a dangerous doctrine
of "corporate conscience" may be born of the contraception controversy.
Already, a number of courts have indicated a willingness to accept that
artificial business entities incorporated for secular, profit-making
aims have religious beliefs and consciences that excuse them from
compliance with law. Their reasoning repudiates longstanding foundations
of corporate law. It transforms conscience, which is inherently human,
into the province of business entities.
Drawing on health law
and policy, I argue that these courts fundamentally misunderstand the
nature of health benefits. Health insurance is a form of compensation,
earned by and belonging to the employee like wages. By neglecting this
economic reality, courts draw incorrect conclusions about the
responsibility, legal and moral, of employers for the contents of their
employeesâ€™ insurance plans, and thus about the burden that any
regulation imposes. Moreover, courts fail to recognize that the role the
ACA ascribes to private employers bears striking similarity to other
comprehensive social insurance schemes, all of which have faced and
survived challenges based on free exercise. Any employer responsibility
for employer-based insurance should be analyzed under this precedent.
Finally, I suggest that "corporate conscience" would destabilize the
rights of employees far beyond the context of contraception. Religiously
affiliated commercial actors already assert rights to defy health and
safety laws, pay women less, and fire pregnant women. If secular
employers succeed in their challenge to the contraception mandate,
gender equality and religious freedom will be at risk in all workplaces.
- Abstract: In recent years, conscience has
become a national catch phrase, invoked regularly in health policy
discussions. The word "conscience," however, often stands in for
refusal to deliver abortions or contraception or to remove or
withhold life support.
In this talk, I argue that conscience
is not so one-sided, nor medical decisionmaking so straightforward.
First, medical decisions - especially those involving questions of
life and death - inspire divergent moral convictions. Second,
medical decisions do not simply implicate conscience for the
provider. They should be thought of instead as involving, at
minimum, three parties: patients, providers, and institutions. This
three-sided relationship complicates moral decisionmaking, with each
party asserting potentially conflicting claims.
that in responding to conflicts over medical decisions, lawmakers
have overlooked their complexity. As a result, existing legislation
undermines conscience, risks harm to patients, and destabilizes
ethical decisionmaking within medicine itself. The talk concludes
with several proposals to improve the lawâ€™s approach to morality in
Taking Conscience Seriously. 98
Va. L. Rv. 1501, 1532-39 (2012), Washington University in St.
Louis School of Legal Studies Legal Research Series Paper 13-03-01
- Abstract: For too long, the conventional
account of morality in medicine has placed conscience firmly on one
side of the moral divide. The archetypal doctor who refuses to
participate in controversial treatments - most commonly end-of-life
care, abortion, sterilization, and contraception - has been the
lodestar of legislative efforts and scholarly accounts. In the name
of institutional conscience, healthcare facilities have also been
permitted to assert moral or religious objections to care and impose
them on employees and affiliates of all beliefs and backgrounds.
Doctors, nurses, and institutions that are willing to deliver
controversial care have been virtually absent from discussions. This
Article aims to reframe the debate by taking conscience seriously.
Through engagement with the moral philosophical literature, it makes
two inter-related arguments. First, conscience equally may compel a
doctor or nurse to deliver a controversial treatment to a patient in
need. Yet existing legislation meant to protect conscience,
paradoxically, has undermined the consciences of these doctors and
nurses. Second, endowing healthcare institutions with conscience via
legislation is theoretically and practically problematic. By
privileging the institutionsâ€™ rights to refuse to provide certain
treatments, legislation impinges on the rights of individual
providers to provide care they feel obligated by conscience to
deliver. Ultimately, if legislation is to protect conscience, it
must negotiate between competing claims of conscience of health
providers and the facilities in which they work â€” regardless of
whether they refuse or are willing to provide controversial care.
This Article introduces a new framework for achieving a better
balance between the interests of institutions, individual doctors
and nurses, and the patients who depend on them for care.
- In Canada, as in many developed countries, healthcare conscientious
objection is growing in visibility, if not in incidence. Yet the
country's health professional policies on conscientious objection are in
disarray. The article reports the results of a comprehensive review of
policies relevant to conscientious objection for four Canadian health
professions: medicine, nursing, pharmacy and dentistry. Where relevant
policies exist in many Canadian provinces, there is much controversy and
potential for confusion, due to policy inconsistencies and
terminological vagueness. Meanwhile, in Canada's three most northerly
territories with significant Aboriginal populations, whose already
precarious health is influenced by funding and practitioner shortages,
there are major policy gaps applicable to conscientious objection. In
many parts of the country, as a result of health professionals'
conscientious refusals, access to some legal health services - including
but not limited to reproductive health services such as abortion - has
been seriously impeded. Although policy reform on conscientious
conflicts may be difficult, and may generate strenuous opposition from
some professional groups, for the sake of both patients and providers,
such policy change must become an urgent priority.
- An important good for doctors, nurses, and other health care
professionals could be described as that of "professional freedom." This
is the good of being able to bring one's professional medical knowledge
and one's commitments to the norms and values of the medical profession
to bear on one's professional judgments and actions. This is, after all,
one of the important aspects of being in a profession: professionals are
not merely technicians performing the same routine tasks over and over,
nor are they functionaries, blindly carrying out orders from above with
little or no discretion on their part. . .
- Abstract: This article provides a brief
introduction to the interplay between law and religion in the health
care context. First, I address the extent to which the commitments of a
faith tradition may be written into laws that bind all citizens,
including those who do not share those commitments. Second, I discuss
the law's accommodation of the faith commitments of individual health
care providers - hardly a static inquiry, as the degree of accommodation
is increasingly contested. Third, I expand the discussion to include
institutional health care providers, arguing that the legal system's
resistance to accommodating the morally distinct identities of
institutional providers reflects a short-sighted view of the liberty of
conscience. Finally, I offer some tentative thoughts about why these
dynamics become even more complicated in the context of Islamic health
- Freedom of Conscience and Freedom of Religion should be taken to
protect two distinct sets of moral considerations. The former protects
the ability of the agent to reflect critically upon the moral and
political issues that arise in her society generally, and in her
professional life more specifically. The latter protects the
individual's ability to achieve secure membership in a set of practices
and rituals that have as a moral function to inscribe her life in a
temporally extended narrative. Once these grounds are distinguished, it
becomes more difficult to grant healthcare professionals' claims to
religious exemptions on the basis of the latter than it is on the basis
of the former. While both sets of considerations generate 'internal
reasons' for rights to accommodation, the relevant 'external' reasons
present in the case of claims of moral conscience do not possess
analogues in the case of claims of religious conscience. However, the
argument applies only to 'irreducibly religious' claims, that is to
claims that cannot be translated into moral vocabulary. What's more,
there may be reasons to grant the claims of religious persons to
exemptions that have to do not with the nature of the claims, but with
the beneficial effects that the presence of religious persons may have
in the context of the healthcare institutions of multi-faith societies.
- Abstract: The recent confirmation of the
constitutionality of the Obama administration's Patient Protection and
Affordable Care Act (PPACA) by the US Supreme Court has brought to the
fore long-standing debates over individual liberty and religious
freedom. Advocates of personal liberty are often critical, particularly
in the USA, of public health measures which they deem to be overly
restrictive of personal choice. In addition to the alleged restrictions
of individual freedom of choice when it comes to the question of whether
or not to purchase health insurance, opponents to the PPACA also argue
that certain requirements of the Act violate the right to freedom of
conscience by mandating support for services deemed immoral by religious
groups. These issues continue the long running debate surrounding the
demands of religious groups for special consideration in the realm of
health care provision. In this paper I examine the requirements of the
PPACA, and the impacts that religious, and other ideological, exemptions
can have on public health, and argue that the exemptions provided for by
the PPACA do not in fact impose unreasonable restrictions on religious
freedom, but rather concede too much and in so doing endanger public
health and some important individual liberties.
- Dr. Prado flipped the hallway flags outward and pushed his shoulder
into the door. Inside the room a man and woman sat, the woman manifestly
pregnant. They bowed their heads shyly as he entered and then looked up
at him expectantly. . .
- Introduction: In the medical setting,
conscience legislation serves to protect health care professionals who
refuse to provide certain procedures or services that would violate
their consciences. The "Personhood Movement," on the other hand,
is characterized by advocates' attempts to adopt legislation or
constitutional amendments at the state and/or federal level that would
extend the legal and moral protection associated with personhood to
members of the human species at the earliest stages of biological
development. The relationship between conscience legislation and
the Personhood Movement may not be self-evident, but the connection
becomes apparent when considering trends in conscience legislation.
This is particularly true in the context of expanding legal protection
to health care professionals who object to certain forms of birth
control, such as emergency contraception (EC).