Conscientious refusal and health professionals: Does religion make a difference?

Bioethics. doi: 10.1111/bioe.12059

D. Weinstock


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. [Full Text]

Welcome to the wild, wild north

Conscientious Objection Policies Governing Canada’s Medical, Nursing, Pharmacy, and Dental Professions

Bioethics. doi: 10.1111/bioe.12057

J. Shaw, J. Downie


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. [Full Text]

Am I my profession’s keeper?

Bioethics. doi: 10.1111/bioe.12056

A. Kolers


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: ‘anarchism,’ where obligations apply only insofar as they match individual conscience; and ‘totalitarianism,’ 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 – or we conscientiously believe them to be – 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. [Full Text]

Justification for conscience exemptions in health care

Bioethics. doi: 10.1111/bioe.12055

L. Kantymir, C. McLeod


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. [Full Text]

Moral distress and moral conflict in clinical ethics

Bioethics. doi: 10.1111/bioe.12064

C. Fourie


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 distress.

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. [Full Text]

A neglected aspect of conscience: awareness of implicit attitudes

Bioethics. doi: 10.1111/bioe.12058

C. Fitzgerald


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. [Full Text]

Lost in Translation: The Failure of the International Reproductive Rights Norm

 Susan Yoshihara, Ph.D.

CFAM has posted a three part series based on a new paper just published in the Ave Maria Law Review.

Part One: A Norm is Born

NEW YORK, September 13 (C-FAM) For decades, powerful countries and wealthy foundations conducted a campaign to create a global standard for abortion rights. Despite their efforts, the phrase “reproductive health” has been adopted, but not an international norm of reproductive rights. [CFAM Part 1]

Part 2: Reproductive Health Doesn’t Include Abortion . . . But It

NEW YORK, September 20 (C-FAM) The term “reproductive health” seeped without fanfare into UN language in 1972 when it was adopted by Jose Barzelatto, the inaugural head of WHO’s program on human reproduction.  Its first appearance in a UN document was a World Health Organization (WHO) report 20 years later by Barzelatto’s successor, Mahmoud Fathalla. His sprawling description of the term contained “fertility regulation,” which for WHO included “pregnancy interruption,” that is, abortion. [CFAM Part 2]

Part 3: No Norm, No Right

NEW YORK, September 27 (C-FAM) In 2006, the term “reproductive health” made it into a binding international law treaty for the first time, the Convention on the Rights of Persons with Disabilities. While this was a victory for the reproductive rights movement, it produced mixed results.

Twenty-three nations opposed the term. After it was reluctantly included, fifteen made statements reminding the term’s proponents what they had assured them throughout the negotiations: that the term “reproductive health” did not include abortion or create any new rights. [CFAM-Part 3]



Hearings on Quebec Bill 52: Interprofessional Health Federation of Quebec

Régine Laurent, Julie Martin, Michàle Boisclair, Brigitte Doyon

Thursday, 26 September 2013 – Vol. 43 N° 39

Note: The following translation is the product of a first run through Google Translate.  In most cases it is  sufficient to identify statements of interest, but more careful translation is  required to properly understand the text.  Translation block numbers (T#) have been assigned by the Project as references to facilitate analysis and discussion.

Original Text


Caution: raw machine translation

 (version non révisée)
Unrevised version
(Reprise à 12 h 29)
Le Président (M. Bergman) : À l’ordre, s’il vous plaît! Alors, je souhaite la bienvenue à la Fédération interprofessionnelle de la santé du Québec. Bienvenue, mesdames. Vous avez 15 minutes pour faire votre présentation, suivi d’un échange avec les membres de la commission. Je vous demanderais de donner vos noms et vos titres pour commencer votre présentation pour le prochain 15 minutes. 001 The Chairman (Mr. Bergman): Order, please! So I welcome Interprofessional Health Federation of Quebec. Welcome, ladies. You have 15 minutes to make your presentation, followed by a discussion with the members of the commission. I ask you to give your names and titles to begin your presentation for the next 15 minutes.
Mme Laurent (Régine) : Merci. Bonjour. Merci, M. le Président. Bonjour, Mme la ministre. Mmes et MM. les députés. Merci de nous recevoir. 002 Ms. Laurent (Regine): Thank you. Hello. Thank you, Mr. President. Hello, Madam Minister. Mr. and Mrs.. MPs. Thank you for having us.
Alors, avant de commencer, je vous présente à ma droite Mme Julie Martin, qui est conseillère à la fédération, au secteur tâches et organisation du travail; juste à ma gauche, Michèle Boisclair, qui est première vice-présidente à la fédération, et, à la gauche de Mme Boisclair, Mme Brigitte Doyon, qui est conseillère syndicale au secteur sociopolitique. 003 So before I begin, I present you my right Julie Martin, who is an advisor to the federation, the sector tasks and organization of work just to my left, Michàle Boisclair, who is senior vice-president of the federation, and to the left Ms. Boisclair, Brigitte Doyon, who is the union representative socio-political sector.
Alors, merci. On saisit l’opportunité de vous transmettre le point de vue des infirmières, infirmières auxiliaires, inhalothérapeutes de la fédération, tout comme nous l’avions fait en 2010. Ce projet de loi a été attendu par beaucoup de groupes que ce sujet interpelle. De façon générale, la FIQ est en accord avec un bon nombre de principes 004 So, thank you. We took the opportunity to convey the views of nurses, nursing assistants, respiratory therapists of the federation, as we did in 2010. The bill was expected by many groups that this calls. In general, the FIQ is consistent with many of the principles

Full Translation

Hearings on Quebec Bill 52:Council for the Protection of Patients

Paul Brunet

Thursday, 26 September 2013 – Vol. 43 N° 39

Note: The following translation is the product of a first run through Google Translate.  In most cases it is  sufficient to identify statements of interest, but more careful translation is  required to properly understand the text.  Translation block numbers (T#) have been assigned by the Project as references to facilitate analysis and discussion.

Original Text


Caution: raw machine translation

11 h 30 (version non révisée)
Unrevised version

(Onze heures trente-trois minutes) 

Le Président (M. Bergman) : À l’ordre, s’il vous plaît! Alors, ayant constaté le quorum, je déclare la séance de la Commission de la santé et des services sociaux ouverte. La commission est réunie afin de poursuivre les consultations particulières et les auditions publiques sur le projet de loi n° 52, Loi concernant les soins de fin de vie. 001 The Chairman (Mr. Bergman): Order, please! So, having established a quorum, I declare the meeting of the Board of Health and Social Services opened. The Committee met to continue the special consultations and public hearings on Bill 52, An Act respecting the end-of-life.
Mme la secrétaire, y a-t-il des remplacements. 002
La Secrétaire : Non, M. le Président. 003
Le Président (M. Bergman) : Alors, collègues, ce matin on reçoit le Conseil pour la protection des malades, Me Paul Brunet, le président. Alors, Me Brunet, bienvenue. Vous avez 15 minutes pour faire votre présentation, suivie d’un échange avec les membres de la commission. Alors, le micro est à vous. 004 The Chairman (Mr. Bergman): So, gentlemen, this morning we received the Council for the Protection of Patients, Mr. Paul Brunet, President. So, Mr. Brunet, welcome. You have 15 minutes to make your presentation, followed by a discussion with the members of the commission. So the microphone is yours.
M. Brunet (Paul G.) : Merci, M. le Président. Messieurs dames, Mme la ministre, messieurs dames les parlementaires, merci de nous inviter, le Conseil pour la protection des malades. Nous fêterons nos 40 ans, en 2014. Nous avons sollicité le gouvernement pour avoir une aide pour célébrer ces 40 ans avec lui. Nous espérons que le gouvernement sera avec le conseil qui, à mon avis, est devenu une institution, parmi d’autres, importante, dans notre société. Je voulais signaler aussi que ma collègue, Mme Hasbrouck, le l’organisme Toujours vivant, n’a toujours pas été invitée par la commission. J’espère qu’on pourra l’entendre parce que, bien que je ne partage pas son point de vue, elle mérite, elle et son organisme, d’être entendue. Bravo aux membres de l’Assemblée nationale qui, tous partis confondus, avez eu le courage de mettre par écrit ce projet de loi si important pour, à mon avis, clarifier certaines choses importantes, dans notre société, c’est-à-dire, notamment le droit pour une personne lourdement handicapée, gravement malade, dont la mort est inévitable, à décider elle-même et pour elle-même de ce qui va lui arriver et quand cela va lui arriver. 005 Mr. Brunet (Paul G. ) : Thank you, Mr. President. Ladies and gentlemen , Madam Minister , ladies and gentlemen Members, thank you for inviting us , the Council for the protection of patients . We will celebrate our 40 years in 2014. We asked the government for help to celebrate these 40 years with him . We hope that the Government will be with the board , in my opinion, has become an institution , among others, important in our society . I also wanted to mention that my colleague, Ms. Hasbrouck, the organization Still alive , still has not been requested by the commission. I hope we can hear it because , although I do not share his point of view , she deserves her and her body , to be heard. Congratulations to the members of the National Assembly , all parties, have had the courage to write this bill so important , in my opinion , to clarify some important things in our society , that is to say including the right to a severely disabled person , seriously ill, whose death is inevitable, to decide for itself and for itself what will happen to him and when that will happen to him .

Full Translation

Irish hospital agrees to comply with abortion law

The Mater Hospital in Dublin has announced that it will comply with Ireland’s new abortion law, which requires designated institutions, including the Mater, to provide abortions approved under the terms of the statute.  Father Kevin Doran, a member of the board of directors, had previously stated  that the hospital could not comply with the law. [The Journal]