Selective conscientious objection, a refusal to participate in a specific war due to reasons of conscience, has recently gained attention. A combatant confronted with such a decision needs guidance to help decide whether and how to object. Furthermore, those judging a combatant’s objection or failure to object need guidance. After introducing the prima facie duty override criteria, I will apply the criteria to the case of selective conscientious objection. Ultimately, I argue that the (...) jus ad bellum criteria rebranded as the prima facie duty override criteria can help provide guidance regarding selective conscientious objection. (shrink)

Most discussions of conscientious objection in healthcare assume that the objection is universal: a doctor objects to all abortions. I want to investigate selective objections, where a doctor objec...

Assume that military professionals should have the right to exercise selective conscientious objection (SCO). Implementing policies and programs to facilitate the right to SCO would be tricky. This essay offers suggestions for how to proceed.

The purpose of this paper is to consider the following three problems:(1) Whether selective conscientious objection is morally reasonable in general; and if so,(2) Whether selective conscientious objection should be recognized as a constitutional right by judicial interpretation; or(3) Whether selective conscientious objection should become part of any new draft law that would be passed by Congress.

Official tolerance of those who have a principled objection to serving in all wars, and refuse to fight, is well established in most Western states. Conscientious objectors of this sort are excused...

This paper discusses some of the practical difficulties confronting Jeff McMahan’s proposal of a jus ad bellum court of experts for deciding the justice of war, and recommends two revisions. First, following the earlier proposals of Vitoria, Suarez, and Grotius, leaders could have a say in appointing judges to the ad bellum court; second, the court could be an organ of the International Criminal Court. Though significant practical challenges remain, these revisions make McMahan’s proposal fairer to democratic governments, and give (...) the court a better chance for successful implementation in the prevailing Westphalian system of state sovereignty. (shrink)

This paper discusses some of the practical difficulties confronting Jeff McMahan’s proposal of a jus ad bellum court of experts for deciding the justice of war, and recommends two revisions. First, following the earlier proposals of Vitoria, Suarez, and Grotius, leaders could have a say in appointing judges to the ad bellum court; second, the court could be an organ of the International Criminal Court. Though significant practical challenges remain, these revisions make McMahan’s proposal fairer to democratic governments, and give (...) the court a better chance for successful implementation in the prevailing Westphalian system of state sovereignty. (shrink)

Conscientious objectors to military service are either general objectors or selective objectors. The former object to all wars; the latter object to only some wars. There is widespread popular and political support in western liberal democracies for exemptions for general objectors, but currently there is little support for exemptions for selective objectors. Many who advocate exemptions for selective objectors attempt to build upon the strength of support that is enjoyed by exemptions for general objectors. They argue (...) that selective objectors ? like general objectors ? sincerely believe that it would be deeply morally wrong for them to fight in the wars to which they object. I argue that a stronger moral case for exemptions for selective objectors relies upon a different claim: selective objections are often accurate. It is often immoral to fight in the wars to which selective objectors object. While some advocates of exemptions for selective objectors have identified accuracy as a reason for offering exemptions, they have usually not adequately distinguished sincerity from accuracy. However, keeping these two moral reasons for exemptions distinct clarifies and strengthens the moral case for exemptions for selective conscientious objectors. (shrink)

Whether refusal is an act of civil disobedience meant to challenge the state politically as a form of protest, or an action which reflects a deep moral objection to the policies of the state, selective conscientious objection presents the state and its citizens with a number of difficult legal and moral challenges. Appeals to authority outside of the state, whether religious or secular, influence both citizenship and the behavior of the government itself. As Israel raises funds (...) to defend IDF officers from charges of human rights violations in the United Kingdom, it may find itself in need of a better defense against those citizens hesitant to be placed in harm's way, militarily and legally. At some point in the future it may find itself unable to field soldiers for whom service in the Occupied Territories is prohibited by inviolable secular or religious law. And for those who will continue to argue that they cannot abide service in an army of occupation, an expression sounded in 1968 by Yeshayahu Leibowitz, the moral crisis of an individual conscience rent between obligations to the state and obligations to self, will linger along with the pain of a conscience nurtured and then rejected by this democratic society. (shrink)

Whether refusal is an act of civil disobedience meant to challenge the state politically as a form of protest, or an action which reflects a deep moral objection to the policies of the state, selective conscientious objection presents the state and its citizens with a number of difficult legal and moral challenges. Appeals to authority outside of the state, whether religious or secular, influence both citizenship and the behavior of the government itself. As Israel raises funds (...) to defend IDF officers from charges of human rights violations in the United Kingdom, it may find itself in need of a better defense against those citizens hesitant to be placed in harm's way, militarily and legally. At some point in the future it may find itself unable to field soldiers for whom service in the Occupied Territories is prohibited by inviolable secular or religious law. And for those who will continue to argue that they cannot abide service in an army of occupation, an expression sounded in 1968 by Yeshayahu Leibowitz, the moral crisis of an individual conscience rent between obligations to the state and obligations to self, will linger along with the pain of a conscience nurtured and then rejected by this democratic society. (shrink)

Most democratic states tolerate, to various extents, conscientious objection. The same states tend not to tolerate acts of civil disobedience and what they perceive as selective conscientious objection. In this paper it is claimed that the dichotomy between civil disobedience and conscientious objection is often misguided; that the existence of a “civic conscience” makes it impossible to differentiate between conscientious objection and civil disobedience; and that there is no such thing as (...) “selective” conscientious objection—or that classifying an objection as “selective” has no significant moral or practical implications. These claims are supported by a preliminary, more general argument according to which conscientious objection is and should be tolerated because the objector lacks the ability to choose his conscience and to decide whether to act upon it. The lack-of-choice argument, it is claimed, applies equally to all types of conscientious objection, including those that are mistakenly called “selective” objection. It also applies to one type of civil disobedience. As a result, if a state is willing to tolerate non-selective conscientious objection, it may and at times must also tolerate selective conscientious objection and civil disobedience and to a similar degree. (shrink)

The American Medical Association opinion “Physician Exercise of Conscience” is generally sound; its recommendations regarding notice, nondiscrimination, informed consent, referral, and non-abandonment are reasonable. Within its focus on individual physicians’ duties to particular patients, it could also emphasize that physicians should only share the reasons for their objections if patients express an interest and that they should only share the reasons in a respectful manner. The opinion, however, neglects wider time frames and higher levels of organization. It could comment on (...) physicians’ duty to form their consciences appropriately and to select specialities and practice settings that do not engender excessive conflicts. Given the number of physicians who are not self-employed and the role of law in establishing rights and responsibilities, the opinion could also address employers’, legislatures’, and courts’ obligations to balance protecting physicians’ integrity and assuring patients’ access to medical treatment. Addressing these wider perspectives would greatly strengthen the opinion. (shrink)

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.

Just war theory entails that some wars may be morally unjustifiable, and hence citizens may be right to object morally to their government''s waging of a war and to their being compelled to serve in it. Given the evils attendant upon even justified war, this fact sharply restricts any obligation to die for the state, and raises important questions about the appropriate state response to selective conscientious objectors. This paper argues that such people should be legally accommodated, and (...) discusses objections to doing so, in particular, the possible erosion of the state''s capacity to wage justified war, the unfairness of granting such exemptions from military service, and the impossibility of determining genuinely conscientious objection. (shrink)

Background and objectives Conscientious refusal of abortion has been discussed widely by medical ethicists but little information on practitioners' opinions exists. The American College of Obstetricians and Gynecologists (ACOG) issued recommendations about conscientious refusal. We used a vignette experiment to examine obstetrician-gynecologists' (OB/GYN) support for the recommendations. Design A national survey of OB/GYN physicians contained a vignette experiment in which an OB/GYN doctor refused a requested elective abortion. The vignette varied two issues recently addressed by the ACOG ethics (...) committee—whether the doctor referred and whether the doctor disclosed their objection to the abortion. Participants and setting 1800 OB/GYN randomly selected physicians were asked to complete a mail survey containing the vignette. The response rate was 66% (n=1154) after excluding 40 ineligible cases. Measurement Physicians indicated their approval for the vignette doctor's decision. Main results Overall, 43% of OB/GYN physicians responded that the conscientious refusal exercised by the vignette physician was appropriate. 70% rated the vignette doctor as acting appropriately when a referral was made. This dropped to 51% when the doctor disclosed objections to the patient, and to 12% when the doctor disclosed objections and refused to make a referral. Consistent with previous research, males were more likely to support disclosure and refusal to refer. Highly religious physicians supported non-referral but not disclosure. Conclusion OB/GYN physicians are less likely to support conscientious refusal of abortion if physicians disclose their objections to patients. This is at odds with ACOG recommendations and with some models of the doctor–patient relationship. (shrink)

What is conscientious objection? -- Should conscientious objectors be accommodated? -- Assessing objectors' beliefs and reasons -- Accommodation and conscientious provision.

In lieu of an abstract, here is a brief excerpt of the content:Nursing Ethics:A Selected Bibliography, 1987 to PresentDoris Mueller Goldstein (bio)The ethics of nursing is emerging as a discipline distinct from bioethics or medical ethics. Although these areas have many concerns in common, nurses are demonstrating that their perspective can make a unique contribution to ethical debate.An especially dynamic area of discussion within nursing ethics is the philosophy of caring. The work on moral development by Harvard educator Carol Gilligan (...) in her book, In a Different Voice, is pivotal in this discussion (IV B, Cooper 1989). Jean Watson, a nurse at the University of Colorado Center for Human Caring, also has written extensively on the philosophy of caring. She states that "an ethic of caring has a distinct moral position: caring is attending and relating to a person in such a way that the person is protected from being reduced to the moral status of objects...." (I, Watson 1988).Even as the philosophy of caring becomes more predominant, however, nurses today are often drawn away from the caring role by forces prevalent in the modern hospital. First, modern technology can divert the nurse's attention away from the patient and toward the operation of complex equipment, and second, large hospitals are often managed as bureaucracies (I, Fitzpatrick 1988).A recent study examined the frequency and seriousness of ethical issues encountered in nursing practice (IV A, Berger 1991). A survey instrument that included 32 potential ethical issues was developed by the authors. Respondents were asked to identify what kinds of issues concerned them and with what frequency, and to indicate what resources were used to cope with these dilemmas. The study found that nurses were frequently faced with inadequate staffing, heroic measures for prolonging life, inappropriate resource allocation, situations where patients are being discussed inappropriately, and coping with irresponsible activity of colleagues.The variety of ethical dilemmas encountered on a daily basis by nurses and their expressed interest in developing a moral grounding for the profession of [End Page 177] nursing, along with increased attention to ethical issues in nursing education have led to an explosion in the literature on these topics. In the preparation of this bibliography over 1,000 citations were retrieved in computer searches of various databases: BIOETHICSLINE, MEDLINE and CATLINE (National Library of Medicine), CINAHL (Current Index to Nursing and Allied Health Literature), BOOKS IN PRINT PLUS, and ETHX (the online public access catalog for articles at the National Reference Center for Bioethics Literature). What is offered here is a small sampling of that literature. Books and special issues of periodicals are briefly annotated, but citations to articles are simply arranged by broad subject, and within that, alphabetically by author. The subcategories reflect the topics receiving the most discussion in current literature.This bibliography updates "The Ethics of Nursing: A Selected Bibliography," by Doris Mueller Goldstein, which covered the earlier literature and was published as an appendix to Ethical Decision Making in Nursing Administration (I, Silva 1990).I. BooksAustralian Nursing Federation. Ethics: Nursing Perspectives, vol. 2. North Fitzroy, Victoria: The Federation, 1989. 102 p. (Publisher's address: 373-375 St. Georges Road, postal code 3068.) The National Professional Development Committee of Australia fostered the publication of a second volume of papers on nursing ethics. Articles cover patients' rights, ethical theory in decisionmaking behaviors, the nurse and the DNR order, and whistleblowing. Several appendices represent difficult-to-obtain documents, such as the RANF (Royal Australian Nursing Federation) position statements on terminal care, AIDS and occupational health, professional practice problems, and conscientious objection.Bandman, Elsie L., and Bandman, Bertram. Nursing Ethics Through the Life Span. 2nd ed. Norwalk, CT: Appleton & Lange, 1990. 288 p. Following an extensive review of the moral foundations of decision making in nursing, the authors take the reader through a chronology of nursing ethics issues as they occur in the human life span, beginning with the procreative family period and concluding with the end of life. Each chapter contains discussion questions—an aid to educators using this as a textbook.Benjamin, Martin, and Curtis, Joy. Ethics in Nursing. 2nd ed. New York: Oxford University Press, 1986. 206 p. An overview of the nature of ethical inquiry and theory is followed by... (shrink)

The literature on conscientious objection in medicine presents two key problems that remain unresolved: 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? How does one respect both medical practitioners’ claims of conscience and patients’ interests, without leaving practitioners complicit in perceived or actual wrongdoing? 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: an “Uber Conscientious Objection in Medicine 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; medical practitioners should advertise their 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. (shrink)

(1979). CONSCIENTIOUS OBJECTION AGAINST WARFARE: A Juridical Perspective from the Calvinistic Point of View. Philosophical Papers: Vol. 8, No. 1, pp. 56-64.

Most proponents of conscientious objection accommodation in medicine acknowledge that not all conscientious beliefs can justify refusing service to a patient. Accordingly, they admit that constraints must be placed on the practice of conscientious objection. I argue that one such constraint must be an assessment of the reasonability of the conscientious claim in question, and that this requires normative justification of the claim. Some advocates of conscientious object protest that, since conscientious claims (...) are a manifestation of personal beliefs, they cannot be subject to this kind of public justification. In order to preserve an element of constraint without requiring normative justification of conscientious beliefs, they shift the justificatory burden from the belief motivating the conscientious claim to the condition of the patient being refused service. This generally involves a claim along the lines that conscientious refusals should be permitted to the extent that they do not cause unwarranted harm to the patient. I argue that explaining what would constitute warranted harm requires an explanation of what it is about the conscientious claim that makes the harm warranted. ‘Warranted’ is a normative operator, and providing this explanation is the same as providing normative justification for the conscientious claim. This shows that resorting to facts about the patient’s condition does not avoid the problem of providing normative justification, and that the onus remains on advocates of conscientious objection to provide normative justification for the practice in the context of medical care. (shrink)

Historically associated with military service, conscientious objection has become a significant phenomenon in health care. Mark Wicclair offers a comprehensive ethical analysis of conscientious objection in three representative health care professions: medicine, nursing and pharmacy. He critically examines two extreme positions: the 'incompatibility thesis', that it is contrary to the professional obligations of practitioners to refuse provision of any service within the scope of their professional competence; and 'conscience absolutism', that they should be exempted from performing (...) any action contrary to their conscience. He argues for a compromise approach that accommodates conscience-based refusals within the limits of specified ethical constraints. He also explores conscientious objection by students in each of the three professions, discusses conscience protection legislation and conscience-based refusals by pharmacies and hospitals, and analyzes several cases. His book is a valuable resource for scholars, professionals, trainees, students, and anyone interested in this increasingly important aspect of health care. (shrink)

This article argues that practitioners have a professional ethical obligation to dispense emergency contraception, even given conscientious objection to this treatment. This recent controversy affects all medical professionals, including physicians as well as pharmacists. This article begins by analyzing the option of referring the patient to another willing provider. Objecting professionals may conscientiously refuse because they consider emergency contraception to be equivalent to abortion or because they believe contraception itself is immoral. This article critically evaluates these reasons and (...) concludes that they do not successfully support conscientious objection in this context. Contrary to the views of other thinkers, it is not possible to easily strike a respectful balance between the interests of objecting providers and patients in this case. As medical professionals, providers have an ethical duty to inform women of this option and provide emergency contraception when this treatment is requested. (shrink)

This paper follows on from a brief debate about the role of conscientious objection in healthcare, where the issue arose as to whether conscientious objection is (or can) be a tool of resistance against systemic injustice. The paper contributes to this debate by highlighting that some authors generally opposed to conscientious objection in healthcare have shown some support to this idea. Perhaps if there is one area in which all can agree, it is that (...) in healthcare conscientious objection should be allowed so as to prevent cases of systemic injustice. (shrink)

Conscientious objection has spurred impassioned debate in many Western countries. Some Norwegian general practitioners (GPs) refuse to refer for abortion. Little is know about how the GPs carry out their refusals in practice, how they perceive their refusal to fit with their role as professionals, and how refusals impact patients. Empirical data can inform subsequent normative analysis.

Defenders of medical professionals’ rights to conscientious objection (CO) regarding emergency contraception (EC) draw an analogy to CO in the military. Such professionals object to EC since it has the possibility of harming zygotic life, yet if we accept this analogy and utilize jurisprudence to frame the associated public policy, those who refuse to dispense EC would not have their objection honored. Legal precedent holds that one must consistently object to all forms of the relevant activity. In (...) the case at hand, then, I argue that these professionals must also oppose morally innocuous practices that may prevent pregnancy after fertilization. These results reveal that such objectors cannot offer a plausible and consistent objection to harming zygotic life. Additionally, there are good reasons to reject the analogy itself. In either case, these findings call into question the case supporting refusals of EC based on scruples. (shrink)

Background:The concept of conscientious objection is well described; however, because of its nature, little is known about real experiences of nursing professionals who apply objections in their practice. Extended roles in nursing indicate that clinical and value-based dilemmas are becoming increasingly common. In addition, the migration trends of the nursing workforce have increased the need for the mutual understanding of culturally based assumptions on aspects of health care delivery.Aim:To present (a) the arguments for and against conscientious (...) class='Hi'>objection in nursing practice, (b) a description of current regulations and practice regarding conscientious objection in nursing in Poland and the United Kingdom, and (c) to offer a balanced view regarding the application of conscientious objection in clinical nursing practice.Design:Discussion paper.Ethical considerations:Ethical guidelines has been followed at each stage of this study.Findings:Strong arguments exist both for and against conscientious objection in nursing which are underpinned by empirical research from across Europe. Arguments against conscientious objection relate less to it as a concept, but rather in regard to organisational aspects of its application and different mechanisms which could be introduced in order to reach the balance between professional and patient’s rights.Discussion and conclusion:Debate regarding conscientious objection is vivid, and there is consensus that the right to objection among nurses is an important, acknowledged part of nursing practice. Regulation in the United Kingdom is limited to reproductive health, while in Poland, there are no specific procedures to which nurses can apply an objection. The same obligations of those who express conscientious objection apply in both countries, including the requirement to share information with a line manager, the patient, documentation of the objection and necessity to indicate the possibility of receiving care from other nurses. Using Poland and the United Kingdom as case study countries, this article offers a balanced view regarding the application of conscientious objection in clinical nursing practice. (shrink)

In a recent article in this journal, Savulescu and Schuklenk defend and extend their earlier arguments against a right to medical conscientious objection in response to criticisms raised by Cowley. I argue that while it would be preferable to be less accommodating of medical conscientious than many countries currently are, Savulescu and Schuklenk's argument that conscientious objection is ‘simply unprofessional’ is mistaken. The professional duties of doctors should be defined in relation to the interests of (...) patients and society, and for reasons set out in this article, these may support limited accommodation of conscientious objection on condition that it does not impede access to services. Moreover, the fact that conscientious objection appears to involve unjustifiable compromise from the objector's point of view is not a reason for society not to offer that compromise. Arguing for robust enforcement of the no-impediment condition, rather than opposing conscientious objection in principle, may be a more effective way of addressing the harms resulting from an over-permissive conscientious objection policy. (shrink)

Robert Card’s “Reasonability View” is a significant contribution to the debate over the place of conscientious objection in health care. In his view, conscientious objections can only be accommodated if the grounds for the objection meet a reasonability standard. I identify inconsistencies in Card’s description of the reasonability standard and argue that each version he specifies is unsatisfactory. The criteria for reasonability that Card sets out most frequently have no clear underpinning principle and are too permissive (...) of immoral objections. Card has also claimed that petitioners must justify their positions with Rawlsian public reason. I argue that, although the resulting reasonability standard is principled, it is overly restrictive. I also show that a reasonability standard built on Rawls’ more lenient conception of reasonableness would be overly permissive of objections at odds with professional healthcare standards. Finally, I argue for my favored solution, which bases the reasonability standard on minimal professional standards. (shrink)

Is conscientious objection necessarily incompatible with the role and duties of a healthcare professional? An influential minority of writers on the subject think that it is. Here, we outline...

The paper deals with the critical questioning of the relation between legitimate imposed legal obligations and the rights to refuse these obligations based on the right of the freedom of conscience, i.e. conscientious objection. The critical perspective that is applied to conduct the questioning is a legal profession because, in Croatian legal culture, there is no articulated answer to the question of how to reconcile these two obligations within the legal profession. The paper draws on the comprehension of (...) John Rawls’s theory of conscientious objection since it is a systematic analysis of justice that shall submit subjective understanding of the good to the principle of right. In practice, the focus is on the grounds for acknowledging conscientious objection among lawyers as well on the obstacles to exercising this right. (shrink)

Benjamin Zolf, in his recent paper ‘No conscientious objection without normative justification: Against conscientious objection in medicine’, attempts to establish that in order to rule out arbitrary conscientious objections, a reasonability constraint is necessary. This, he contends, requires normative justification, and the subjective beliefs that ground conscientious objections cannot easily be judged by normative criteria. Zolf shows that the alternative of using extrinsic criteria, such as requiring that unjustified harm must not be caused, are (...) likewise grounded on normative criteria. He concludes that conscientious objection is therefore untenable. Here, I present an alternative account, based on the value we are willing to place on conscientious objection as an expression of freedom of conscience and religion. Using an extrinsic criterion such as harm, we can make a judgement of what degree of harm should be tolerated as the cost of permitting conscientious objection. A normative criterion for judging individual claims is therefore not required. (shrink)

A dogma accepted in many ethical, religious, and legal frameworks is that the reasons behind conscientious objection (CO) in healthcare cannot be evaluated or judged by any institution because conscience is individual and autonomous. This paper shows that this background view is mistaken: the requirement to reveal and explain the reasons for conscientious objection in healthcare is ethically justified and legally desirable. Referring to real healthcare cases and legal regulations, this paper argues that these reasons should (...) be evaluated either ex ante or ex post and defends novel conceptual claims that have not been analyzed in the debates on CO. First, a moral threshold requirement: CO is only justified if the reasons behind a refusal are of a moral nature and meet a certain threshold of moral importance. Second, this paper considers the rarely discussed conceptual similarities between CO in healthcare and the legal regulations concerning military refusals that place the burden of proof on conscientious objectors. This paper concludes that conscientious objection in healthcare can be accommodated only in some cases of destroying or killing human organisms. (shrink)

It is argued that the primary aim of institutional management is to protect the moral integrity of health professionals without significantly compromising other important values and interests. Institutional policies are recommended as a means to promote fair, consistent, and transparent management of conscience-based refusals. It is further recommended that those policies include the following four requirements: (1) Conscience-based refusals will be accommodated only if a requested accommodation will not impede a patient’s/surrogate’s timely access to information, counseling, and referral. (2) Conscience-based (...) refusals will be accommodated only if a requested accommodation will not impede a patient’s timely access to health care services offered within the institution. (3) Conscience-based refusals will be accommodated only if the accommodation will not impose excessive burdens on colleagues, supervisors, department heads, other administrators, or the institution. (4) Whenever feasible, health professionals should provide advance notification to department heads or supervisors. Formal review may not be required in all cases, but when it is appropriate, several recommendations are offered about standards and the review process. A key recommendation is that when reviewing an objector’s reasons, contrary to what some have proposed, it is not appropriate to adopt an adversarial approach modelled on military review boards’ assessments of requests for conscientious objector status. According to the approach recommended, the primary function of reviews of objectors’ reasons is to engage them in a process of reflecting on the nature and depth of their objections, with the objective of facilitating moral clarity on the part of objectors rather than enabling department heads, supervisors, or ethics committees to determine whether conscientious objections are sufficiently genuine. (shrink)

Vaccine refusal occurs for a variety of reasons. In this article we examine vaccine refusals that are made on conscientious grounds; that is, for religious, moral, or philosophical reasons. We focus on two questions: first, whether people should be entitled to conscientiously object to vaccination against contagious diseases ; second, if so, to what constraints or requirements should conscientious objection to vaccination be subject. To address these questions, we consider an analogy between CO to vaccination and CO (...) to military service. We argue that conscientious objectors to vaccination should make an appropriate contribution to society in lieu of being vaccinated. The contribution to be made will depend on the severity of the relevant disease, its morbidity, and also the likelihood that vaccine refusal will lead to harm. In particular, the contribution required will depend on whether the rate of CO in a given population threatens herd immunity to the disease in question: for severe or highly contagious diseases, if the population rate of CO becomes high enough to threaten herd immunity, the requirements for CO could become so onerous that CO, though in principle permissible, would be de facto impermissible. (shrink)

The right to conscientious objection in the provision of healthcare is the subject of a lengthy, heated and controversial debate. Recently, a new dimension was added to this debate by the US Supreme Court's decision in Burwell vs. Hobby Lobby et al. which effectively granted rights to freedom of conscience to private, for-profit corporations. In light of this paradigm shift, we examine one of the most contentious points within this debate, the impact of granting conscience exemptions to healthcare (...) providers on the ability of women to enjoy their rights to reproductive autonomy. We argue that the exemptions demanded by objecting healthcare providers cannot be justified on the liberal, pluralist grounds on which they are based, and impose unjustifiable costs on both individual persons, and society as a whole. In doing so, we draw attention to a worrying trend in healthcare policy in Europe and the United States to undermine women's rights to reproductive autonomy by prioritizing the rights of ideologically motivated service providers to an unjustifiably broad form of freedom of conscience. (shrink)

The right to conscientious objection in the provision of healthcare is the subject of a lengthy, heated and controversial debate. Recently, a new dimension was added to this debate by the US Supreme Court's decision in Burwell vs. Hobby Lobby et al. which effectively granted rights to freedom of conscience to private, for-profit corporations. In light of this paradigm shift, we examine one of the most contentious points within this debate, the impact of granting conscience exemptions to healthcare (...) providers on the ability of women to enjoy their rights to reproductive autonomy. We argue that the exemptions demanded by objecting healthcare providers cannot be justified on the liberal, pluralist grounds on which they are based, and impose unjustifiable costs on both individual persons, and society as a whole. In doing so, we draw attention to a worrying trend in healthcare policy in Europe and the United States to undermine women's rights to reproductive autonomy by prioritizing the rights of ideologically motivated service providers to an unjustifiably broad form of freedom of conscience. (shrink)

Patients in Quebec can legally obtain medical assistance in dying (MAID) if they are able to give informed consent, have a serious and incurable illness, are at the end of their lives and are in a situation of unbearable suffering. Since the Supreme Court of Canada’s 2015 Carter decision, access to MAID, under certain conditions, has become a constitutional right. Quebec physicians are now likely to receive requests for MAID from their patients. The Quebec and Canadian laws recognize a physician’s (...) right to conscientious objection, but this right is contested both in the medical ethics literature and in the public sphere. This paper presents the results of a qualitative study conducted with twenty Quebec physicians who did not integrate MAID into their medical practice, either because they were opposed to or deeply ambivalent about MAID. The interviews aimed to explore the reasons – religious and secular – for opposition to or ambivalence towards MAID. The secular reasons given by participants were grouped into four main categories: 1) the ends of medicine and professional identity, 2) the philosophy of palliative medicine and resource allocation in palliative care, 3) benevolent paternalism, the “good death”, and the interests of future selves, 4) the risk of a slippery slope and the protection of vulnerable people. (shrink)

In response to physicians who refuse to provide medical services that are contrary to their ethical and/or religious beliefs, it is sometimes asserted that anyone who is not willing to provide legally and professionally permitted medical services should choose another profession. This article critically examines the underlying assumption that conscientious objection is incompatible with a physician’s professional obligations (the “incompatibility thesis”). Several accounts of the professional obligations of physicians are explored: general ethical theories (consequentialism, contractarianism, and rights-based theories), (...) internal morality (essentialist and non-essentialist conceptions), reciprocal justice, social contract, and promising. It is argued that none of these accounts of a physician’s professional obligations unequivocally supports the incompatibility thesis. (shrink)

Recognition of conscientious objection seems reasonable in relation to controversial and contentious issues, such as physician assisted suicide and abortion. However, physicians also advance conscience‐based objections to actions and practices that are sanctioned by established norms of medical ethics, and an account of their moral force can be more elusive in such contexts. Several possible ethical justifications for recognizing appeals to conscience in medicine are examined, and it is argued that the most promising one is respect for moral (...) integrity. It is also argued that an appeal to conscience has significant moral weight only if the core ethical values on which it is based correspond to one or more core values in medicine. Finally, several guidelines pertaining to appeals to conscience and their ethical evaluation are presented. (shrink)

The purpose of this paper is to show that conscientious objection to military service is essentially not a dilemma of freedom of conscience versus the duty to obey the law, but above all a dilemma between two conflicting patriotic moral obligations. Furthermore, the paper demonstrates that CO is justifiable on the basis of what is known as moderate patriotism, that is, out of a patriotism which is committed simultaneously to universal and particular values. The paper begins with a (...) critical discussion of theoretical weaknesses in liberal thought of CO. Then, the concept of moderate patriotism is presented, followed by a discussion of the notion of patriotic CO. The next stage presents a step Towards A Theory of PCO to Military Service and shows how it differs from other liberal theories of disobedience. The conclusion is that if CO on patriotic grounds is morally justifiable, it follows that this is an act committed within the framework of legitimate political discourse. Therefore, PCO is politically legitimate even if it is not always legal. In other words, the discussion of PCO offers a theoretical distinction between politicallegitimacy and legality. (shrink)

Here we respond to Shaw et al., and show why the application of Conscientious Objection cannot be dismissed from cases of organ donation, where the donor is presumed to be dead.

To inform the ongoing discussion of whether claims of conscientious objection allow medical professionals to refuse to perform tasks that would otherwise be their duty, this paper begins with a review of the philosophical literature that describes conscience as either a moral sense or the dictate of reason. Even though authors have starkly different views on what conscience is, advocates of both approaches agree that conscience should be obeyed and that keeping promises is a conscience-given moral imperative. The (...) paper then considers exemplars of conscientious objection—Henry David Thoreau, Mohandas Gandhi, and Martin Luther King Jr.—to identify the critical feature of conscientious objection as willingness to bear the burdens of one’s convictions. It concludes by showing that medical professionals who put their own interests before their patients’ welfare violate their previous commitments and misappropriate the title “conscientious objector” because they are unwilling to bear the burdens of their choices and instead impose burdens on their patients and colleagues. (shrink)