Hec ForumPub Date : 2021-09-01Epub Date: 2020-09-25DOI: 10.1007/s10730-020-09425-5
Jeffrey Byrnes
{"title":"The Problem of \"Core Moral Beliefs\" as the Ground of Conscientious Objection.","authors":"Jeffrey Byrnes","doi":"10.1007/s10730-020-09425-5","DOIUrl":"https://doi.org/10.1007/s10730-020-09425-5","url":null,"abstract":"<p><p>Mark Wicclair's defense of conscientious objection is grounded in an effort to respect the core moral beliefs of health care providers. While such a theoretical schema has merit, this paper argues that core moral beliefs should not serve as the basis of conscientious objection in health care because we, as a community, lack reliable access to a person's core moral beliefs and because individuals are prone to be confused about the scope and extent of their core moral beliefs. Furthermore, a person's confusion over their core moral beliefs is likely to be exacerbated when they lack time to investigate those beliefs and are under heightened external pressure to do so-both conditions frequently encountered by health care providers. Finally, the paper considers whether grounding conscientious objection in core moral beliefs might have the unintended consequence of further entrenching the practical problems that the move is aiming to solve.</p>","PeriodicalId":46160,"journal":{"name":"Hec Forum","volume":"33 3","pages":"291-305"},"PeriodicalIF":1.5,"publicationDate":"2021-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1007/s10730-020-09425-5","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"38421983","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"哲学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Hec ForumPub Date : 2021-09-01DOI: 10.1007/s10730-019-09378-4
Valerie Fleming, Lucy Frith, Beate Ramsayer
{"title":"Tensions Between Ethics and the Law: Examination of a Legal Case by Two Midwives Invoking a Conscientious Objection to Abortion in Scotland.","authors":"Valerie Fleming, Lucy Frith, Beate Ramsayer","doi":"10.1007/s10730-019-09378-4","DOIUrl":"10.1007/s10730-019-09378-4","url":null,"abstract":"<p><p>This paper examines a legal case arising from a workplace grievance that progressed to being heard at the UK's Supreme Court. The case of Doogan and Wood versus Greater Glasgow and Clyde Health Board concerned two senior midwives in Scotland, both practicing Roman Catholics, who exercised their perceived rights in accordance with section 4(1) of the Abortion Act not to participate in the treatment of women undergoing abortions. The key question raised by this case was: \"Is Greater Glasgow and Clyde Health Board entitled to require the midwives to delegate, supervise and support staff in the treatment of patients undergoing termination of pregnancy?\" The ethical issues concerning conscientious objection to abortion have been much debated although the academic literature is mainly concerned with the position of medical practitioners rather than what the World Health Organization terms \"mid-level professionals\" such as midwives. This paper examines the arguments put forward by the midwives to justify their refusal to carry out tasks they felt contravened their legal right to make a conscientious objection. We then consider professional codes, UK legislation and church legislation. While the former are given strong weighting the latter was been ignored in this case, although cases in other European countries have been prevented from escalating to such a high level by the intervention of prominent church figures. The paper concludes by stating that the question put to the courts remains as yet unanswered but offers some recommendations for future policy making and research.</p>","PeriodicalId":46160,"journal":{"name":"Hec Forum","volume":"33 3","pages":"189-213"},"PeriodicalIF":1.5,"publicationDate":"2021-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8390396/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"37389966","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"哲学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Hec ForumPub Date : 2021-09-01DOI: 10.1007/s10730-020-09401-z
Nir Ben-Moshe
{"title":"Conscientious Objection in Medicine: Making it Public.","authors":"Nir Ben-Moshe","doi":"10.1007/s10730-020-09401-z","DOIUrl":"https://doi.org/10.1007/s10730-020-09401-z","url":null,"abstract":"<p><p>The literature on conscientious objection in medicine presents two key problems that remain unresolved: (a) Which conscientious objections in medicine are justified, if it is not feasible for individual medical practitioners to conclusively demonstrate the genuineness or reasonableness of their objections (\"the justification problem\")? (b) How does one respect both medical practitioners' claims of conscience and patients' interests, without leaving practitioners complicit in perceived or actual wrongdoing (\"the complicity problem\")? My aim in this paper is to offer a new framework for conscientious objections in medicine, which, by bringing medical professionals' conscientious objection into the public realm, solves the justification and complicity problems. In particular, I will argue that: (a) an \"Uber Conscientious Objection in Medicine Committee\" (\"UCOM Committee\")-which includes representatives from the medical community and from other professions, as well as from various religions and from the patient population-should assess various well-known conscientious objections in medicine in terms of public reason and decide which conscientious objections should be permitted, without hearing out individual conscientious objectors; (b) medical practitioners should advertise their (UCOM Committee preapproved) conscientious objections, ahead of time, in an online database that would be easily accessible to the public, without being required, in most cases, to refer patients to non-objecting practitioners.</p>","PeriodicalId":46160,"journal":{"name":"Hec Forum","volume":"33 3","pages":"269-289"},"PeriodicalIF":1.5,"publicationDate":"2021-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1007/s10730-020-09401-z","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"37779397","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"哲学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Hec ForumPub Date : 2021-09-01Epub Date: 2021-07-15DOI: 10.1007/s10730-021-09457-5
Bryan Pilkington
{"title":"Considerations of Conscience.","authors":"Bryan Pilkington","doi":"10.1007/s10730-021-09457-5","DOIUrl":"https://doi.org/10.1007/s10730-021-09457-5","url":null,"abstract":"<p><p>The proper role of conscience in healthcare continues to be a topic of deep interest for bioethicists, healthcare professionals, and health policy experts. This issue of HEC Forum brings together a collection of articles about features of these ongoing discussions of conscience, advancing the conversations about conscience in healthcare from a variety of perspectives and on a variety of fronts. Some articles in this issue take up particularly challenging cases of conscientious objection in practice, such as Fleming, Frith, and Ramsayer's contextually rich piece on midwives in Scotland or Harter's professionally grounded analysis; others engage the changing institutional landscapes which impact considerations of conscience, such as Cummins' work on the role of employers in institutional policies about conscience and Ben Moshe's discussion of publicity and institutional committees. Pieces by Howard and Pilkington both raise conceptual considerations about how we think about the role of conscience in medicine, questioning the use of \"conscientious objection\" in these discussions, and Byrnes pushes back on the most influential work in this area by Mark Wicclair. The issue concludes with a piece by Wicclair, which engages each of these distinct offerings, further extending the discussions of conscience in healthcare and helpfully connecting key themes discussed by authors in this issue to his contributions and to the longer tradition of discussions of conscience in medicine. This issue challenges readers to engage different arguments from different perspectives and asks them-in some cases-to be open to revising how they think about the role of conscience and the existence of and justification for conscientious objection in the dynamic, interdisciplinary fields of healthcare.</p>","PeriodicalId":46160,"journal":{"name":"Hec Forum","volume":"33 3","pages":"165-174"},"PeriodicalIF":1.5,"publicationDate":"2021-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1007/s10730-021-09457-5","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"39190352","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"哲学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Hec ForumPub Date : 2021-09-01DOI: 10.1007/s10730-020-09417-5
Dana Howard
{"title":"Civil Disobedience, Not Merely Conscientious Objection, In Medicine.","authors":"Dana Howard","doi":"10.1007/s10730-020-09417-5","DOIUrl":"https://doi.org/10.1007/s10730-020-09417-5","url":null,"abstract":"<p><p>Those arguing that conscientious objection in medicine should be declared unethical by professional societies face the following challenge: conscientious objection can function as an important reforming mechanism when it involves health care workers refusing to participate in certain medical interventions deemed standard of care and legally sanctioned but which undermine patients' rights. In such cases, the argument goes, far from being unethical, conscientious objection may actually be a professional duty. I examine this sort of challenge and ultimately argue that these acts of conscience done in the interest of reforming professional norms or medical regulations are best understood as episodes of civil disobedience rather than episodes of conscientious objection. In contrast to the private, exempting nature of conscientious objection, civil disobedience is a public breach of a norm or law undertaken with the aim of bringing about a change in governmental policies or professional standards. Consequently, clinicians may have a duty to engage in civil disobedience even while professional societies are right to declare limitations on the ethical appropriateness of conscientious objection.</p>","PeriodicalId":46160,"journal":{"name":"Hec Forum","volume":"33 3","pages":"215-232"},"PeriodicalIF":1.5,"publicationDate":"2021-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1007/s10730-020-09417-5","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"38286796","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"哲学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Hec ForumPub Date : 2021-09-01Epub Date: 2021-08-20DOI: 10.1007/s10730-021-09458-4
Mark R Wicclair
{"title":"Commentary: Special Issue on Conscientious Objection.","authors":"Mark R Wicclair","doi":"10.1007/s10730-021-09458-4","DOIUrl":"https://doi.org/10.1007/s10730-021-09458-4","url":null,"abstract":"<p><p>This special issue of HEC Forum includes articles on a wide range of specific topics that make significant contributions to conscientious objection scholarship. In this commentary, it is not feasible to provide a comprehensive analysis of each of the articles; and I have not attempted to do so. Instead, for each article, I have selected specific issues and arguments on which to comment.</p>","PeriodicalId":46160,"journal":{"name":"Hec Forum","volume":"33 3","pages":"307-324"},"PeriodicalIF":1.5,"publicationDate":"2021-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1007/s10730-021-09458-4","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"39331776","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"哲学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Hec ForumPub Date : 2021-09-01DOI: 10.1007/s10730-020-09395-8
Bryan C Pilkington
{"title":"Conscience Dissenters and Disagreement: Professions are Only as Good as Their Practitioners.","authors":"Bryan C Pilkington","doi":"10.1007/s10730-020-09395-8","DOIUrl":"https://doi.org/10.1007/s10730-020-09395-8","url":null,"abstract":"<p><p>In this paper, I consider the role of conscience in medical practice. If the conscientious practice of individual practitioners cannot be defended or is incoherent or unreasonable on its own merits, then there is little reason to support conscience protection and to argue about its place in the current medical landscape. If this is the case, conscience protection should be abandoned. To the contrary, I argue that conscience protection should not be abandoned. My argument takes the form of an analysis of an essential feature of the conscience dissenter's argument, the role of disagreement within \"the medical profession.\" Conscience dissenters make certain assumptions within their arguments about the profession, disagreements within the professions, and how such disagreement should be adjudicated. If it is the case that these assumptions are accurate reflections of the current medical landscape, then the advocate of conscience protection has one less leg to stand on. I aim to show that this is not the case and that the assumptions of the conscience dissenter are not only mistaken but are mistakes of significant magnitude, so significant as to raise serious questions about the merit of their position. If the argument in this paper is sound, then, at the very least, the conversation over conscience protection in medicine, in particular, and health care, in general, must continue.</p>","PeriodicalId":46160,"journal":{"name":"Hec Forum","volume":"33 3","pages":"233-245"},"PeriodicalIF":1.5,"publicationDate":"2021-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1007/s10730-020-09395-8","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"37689496","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"哲学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Hec ForumPub Date : 2021-06-01Epub Date: 2021-03-06DOI: 10.1007/s10730-020-09438-0
Rachel M B Greiner
{"title":"The Cost of Safety During a Pandemic.","authors":"Rachel M B Greiner","doi":"10.1007/s10730-020-09438-0","DOIUrl":"https://doi.org/10.1007/s10730-020-09438-0","url":null,"abstract":"<p><p>A first-person account of some victims of the virus, the author puts faces and circumstances to the tragedy of the Covid-19 pandemic. Told from a chaplain's point of view, these narratives will take the reader beyond the numbers and ask questions like: What is the cost of keeping families separated at the end of life, and, if patient/family centered care is so central to healthcare these days, why was it immediately discarded? Is potentially saving human lives worth the risk of damaging them beyond repair?</p>","PeriodicalId":46160,"journal":{"name":"Hec Forum","volume":"33 1-2","pages":"61-72"},"PeriodicalIF":1.5,"publicationDate":"2021-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1007/s10730-020-09438-0","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"25451694","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"哲学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Hec ForumPub Date : 2021-06-01Epub Date: 2021-03-23DOI: 10.1007/s10730-021-09448-6
Brian H Childs, Laura Vearrier
{"title":"A Journal of the COVID-19 (Plague) Year.","authors":"Brian H Childs, Laura Vearrier","doi":"10.1007/s10730-021-09448-6","DOIUrl":"https://doi.org/10.1007/s10730-021-09448-6","url":null,"abstract":"<p><p>The essays in this special issue of HEC Forum provide reflections that make explicit the implicit anthropology that our current pandemic has brought but which in the medical ethics literature around COVID-19 has to a great extent ignored. Three of the essays are clearly \"journalistic\" as a literary genre: one by a hospital chaplain, one by a medical student in her pre-clinical years, and one by a fourth-year medical student who reports her experience as she completed her undergraduate clerkships and applied for positions in graduate medical education. Other essays explore the pandemic from historical, sociological, and economic perspectives, particularly how triage policies have been found to be largely blind to structural healthcare disparities, while simultaneously unable to appropriately address those disparities. Central issues that need to be addressed in triage are not just whether a utilitarian response is the most just response, but what exactly is the greatest good for the greatest number? Together, the essays in this special issue of HEC Forum create a call for a more anthropological approach to understanding health and healthcare. The narrow approach of viewing health as resulting primarily from healthcare will continue to hinder advances and perpetuate disparities. Health outcomes result from a complex interaction of various social, economic, cultural, historical, and political factors. Advancing healthcare requires contextualizing the health of populations amongst these factors. The COVID-19 pandemic has made us keenly aware of how interdependent our health as a society can be.</p>","PeriodicalId":46160,"journal":{"name":"Hec Forum","volume":"33 1-2","pages":"1-6"},"PeriodicalIF":1.5,"publicationDate":"2021-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1007/s10730-021-09448-6","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"25507984","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"哲学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}