Book Review: Opting Out. Conscience and Cooperation in a Pluralistic Society

Morten Magelssen

Opting Out

In this brief monograph, the philosopher David Oderberg argues that freedom of conscience and religion, as fundamental rights in a liberal democracy, need increased protection in legislation and from the courts. Conscientious objection – in which a professional refuses to perform specific tasks for moral or religious reasons – is especially relevant in healthcare. Oderberg draws most of his examples from this field (e.g. abortion, contraception, treatment-limiting decisions and euthanasia), but also discusses cases from other sectors, such as the bakers and florists who refused to sell goods in connection with gay weddings. . . [Full text]

By David Oderberg. Pp. 136. London: The Institute of Economic Affairs. 2018. Paperback, £12.50; free e-book, at https://iea.org.uk/wp-content/uploads/2018/08/Oderberg-Interactive.pdf. ISBN:978-0-255-36761-5.


Magelssen M.  Book Review: Opting Out. Conscience and Cooperation in a Pluralistic Society.  New Bioethics 2019 Sep; 25(3): 283-286, DOI:10.1080/20502877.2019.1647038.

Conscientious Objection and Clinical Judgement: The Right to Refuse to Harm

Toni C. Saad

The New Bioethics

Abstract
This paper argues that healthcare aims at the good of health, that this pursuit of the good necessitates conscience, and that conscience is required in every practical judgement, including clinical judgment. Conscientious objection in healthcare is usually restricted to a handful of controversial ends (e.g. abortion, euthanasia, contraception), yet the necessity of conscience in all clinical judgements implies the possibility of conscientious objection to means. The distinction between conscientious objection to means and ends is explored and its implications considered. Based on this, it is suggested that conscientious objection, whether to means or ends, occurs when a proposed course of action comes into irreconcilable conflict with the moral principle ‘do no harm’. It is, therefore, concluded that conscientious objection in healthcare can be conceived as a requirement of the moral imperative to do no harm, the right to refuse to harm in regard to health.


Saad TC. Conscientious Objection and Clinical Judgement: The Right to Refuse to Harm. New Bioethics. 2019 Sep; 25(3): 248-261 DOI:10.1080/20502877.2019.1649863

Canada’s bishops allow Catholic hospitals to host consultations for euthanasia

LifeSite News

Lianne Laurence

OTTAWA, April 18, 2019 (LifeSiteNews) – Canada’s bishops were consulted on and agreed to secret guidelines by Catholic health sponsors that allow third-party euthanasia assessments of medically frail patients in Catholic health care facilities, LifeSiteNews has learned.

And while the Catholic health sponsors who drafted the guidelines in collaboration with ethicists and bishops concluded such assessments were not formal cooperation with evil, they failed to consider there are instances when material cooperation is gravely wrong, as is the case here, says Catholic moral theologian, Dr. E. Christian Brugger. . . [Full text]

Discrimination isn’t always wrong

America

John J. Conley

Is discrimination always wrong?

To listen to the current national debate on the topic, it would appear to be so. Virtually all international human-rights covenants categorically reject discrimination on the basis of race, religion and gender. Even contemporary professional philosophers tend to treat discrimination as an unalloyed evil. The University of Chicago’s Brian Leiter has led a very public philosophical campaign to eliminate religious exemptions to anti-discrimination laws and to declare unethical religious practices that appear to be discriminatory, especially in the area of gender and sexual orientation.

But our crusade against discrimination seems to rest on a fundamental confusion. There is a difference between discriminating against someone because of the group to which he or she belongs and discriminating against someone on the basis of his or her actions. . . . [Full text]

Conscientious Objection in Health Care

Letter

Stahl and Emanuel (April 6 issue)1 rightly differentiate between conscripts and physicians. Nonetheless, they state, “the profession . . . uses reflective equilibrium to self-correct. This dynamic process establishes professional obligations . . . regardless of . . . personal beliefs.”1 This point fails to recognize that conscientious objectors are engaging in the dynamic process from within the profession to counter problematic professional obligations and to correct mistakes. . . [Full text]

Liao L,Goligher E.  Conscientious Objection in Health Care, N Engl J Med 2017; 377:96-98 July 6, 2017 DOI: 10.1056/NEJMc1706233

Pro-life medics being forced to choose between career or conscience

Christian Institute

Pro-life medics in the US are ‘under attack’, an academic has warned.

Author and bioethicist, Wesley J. Smith, said medics who are morally opposed to abortion and assisted suicide may soon be forced to choose between “their careers and their convictions”.

He made the comments in an article for First Things, an influential journal of religion and public life.

‘Morally opposed’

In support of his case, he highlighted work published in the New England Journal of Medicine which described abortion as “a standard obstetrical practice” and “not medically controversial”.

Smith said: “The authors take an absolutist position, claiming that personal morality has no place in medical practice.”

He went on to highlight several examples where doctors are being forced to refer patients for abortion and assisted suicide “even if they are morally opposed”. . . . [Full text]

 

Professional and conscience-based refusals: the case of the psychiatrist’s harmful prescription

Morten Magelssen

Abstract

By way of a case story, two common presuppositions in the academic debate on conscientious objection in healthcare are challenged. First, the debate typically presupposes a sharp division between conscience-based refusals based on personal core moral beliefs and refusals based on professional (eg, medical) reasons. Only the former might involve the moral gravity to warrant accommodation. The case story challenges this division, and it is argued that just as much might sometimes be at stake morally in refusals based on professional reasons. The objector’s moral integrity might be equally threatened in objections based on professional reasons as in objections based on personal beliefs. Second, the literature on conscientious objection typically presupposes that conflicts of conscience pertain to well-circumscribed and typical situations which can be identified as controversial without attention to individualising features of the concrete situation. However, the case shows that conflicts of conscience can sometimes be more particular, born from concrete features of the actual situation, and difficult, if not impossible, to predict before they arise. Guidelines should be updated to address such ‘situation-based’ conscientious refusals explicitly.


Magelssen M. Professional and conscience-based refusals: the case of the psychiatrist’s harmful prescription.  Journal of Medical Ethics Published Online First: 24 April 2017. doi: 10.1136/medethics-2017-104162

Further clarity on cooperation and morality

Abstract:  I explore the increasingly important issue of cooperation in immoral actions, particularly in connection with healthcare. Conscientious objection, especially as pertains to religious freedom in healthcare, has become a pressing issue in the light of the US Supreme Court judgement in Hobby Lobby. Section ‘Moral evaluation using the basic principles of cooperation’ outlines a theory of cooperation inspired by Catholic moral theologians such as those cited by the court. The theory has independent plausibility and is at least worthy of serious consideration—in part because it is an instance of double-effect reasoning, which is also independently plausible despite its association with moral theology. Section ‘Case study: Burwell v. Hobby Lobby’ examines Hobby Lobby in detail. Even if the judgement was correct in that case the reasoning was not, as it involved applying a ‘mere sincerity’ test to the cooperation question. The mere sincerity test leads to absurd consequences, whereas a reasonableness test applied using the theory of cooperation defended here would avoid absurdity. Section ‘A question of remoteness: “accommodations” and opt-outs’ explores the post-Hobby Lobby problem further, examining opt-outs and accommodations: the Little Sisters of the Poor case shows how opt-outs are misunderstood on a mere sincerity test, which the court rightly rejected. Section ‘Application to the medical field: Doogan and Wood’ discusses the UK case of Doogan and Wood, concerning participation in abortion. Again, a judicially recognised ethic of cooperation, if it were part of the fabric of legal reasoning in such cases, would have enabled the conscientious objectors in this and similar situations to have their freedom of conscience and religion respected in a way that it currently is not.

Oderberg DS, Further clarity on cooperation and morality.  J Med Ethics doi:10.1136/medethics-2016-103476