Background Healthcare workers frequently face ethically demanding situations in their work, potentially leading to stress of conscience. Long-term work intensification (more and more effort demanded year after year), organizational change and COVID-19 may be risk factors concerning stress of conscience. Aims The main aim was to investigate the relationship between long-term work intensification and stress of conscience among the personnel in a healthcare organization. Organizational change management was considered a mediator and COVID-19-related work (...) class='Hi'>stress a moderator in the association between work intensification and stress of conscience. Research design, participants and context A total of 211 healthcare district employees participated in a longitudinal survey using questionnaires collected in 2019 (major organizational change in the planning stage) and 2021 (organizational change completed). Ethical considerations The study was implemented according to the guidelines of the Finnish National Board on Research Integrity. The Finnish instructions were that no review by an ethics committee was necessary because participation was voluntary, informed consent was requested, participants were assured that they were free to withdraw from the longitudinal study at any time and no health data were collected. Findings Long-term work intensification was associated with more severe stress of conscience. Long-term work intensification was partially mediated through change management to stress of conscience. High COVID-19 stress strengthened the association between long-term work intensification and stress of conscience. Conclusions Long-term work intensification must be addressed to reduce stress of conscience in healthcare, otherwise the healthcare system will be vulnerable to changes and crisis. Extra resources for personnel and management should be allocated because of work intensification during organizational change and health crises like the COVID-19 pandemic to alleviate stress of conscience. (shrink)

Caring for older persons is both rewarding and consuming. Work with older people in Finland has been shown to be more burdensome than in the other Nordic countries. The aim of this study was to try out a Finnish version of the Stress of Conscience Questionnaire (SCQ) and explore stress of conscience in staff caring for older persons in Finland. The data were collected from the nursing staff (n = 350) working with older people in health (...) centre wards, municipal and private nursing homes, and municipal and private dementia care units in Finland. It emerged clearly from the results that Finnish nursing staff mostly felt that they did not have enough time to provide good care to patients, and this gave them a troubled conscience. They also felt that the demanding work taxed their energy, a consequence being that they could not give their own families and loved ones the attention they would have liked. (shrink)

The present study aimed at investigating the relationship between environmental and individual factors and Stress of Conscience among nursing staff in psychiatric in-patient care. A questionnaire involving six different instruments measuring Stress of Conscience, the ward atmosphere, the psychosocial work environment, Perceived Stress, Moral Sensitivity, and Mastery was answered by 93 nursing staff at 12 psychiatric in-patient wards in Sweden. The findings showed that Sense of Moral Burden, Mastery, Control at Work and Angry and Aggressive (...) Behavior were related to Stress of Conscience. We conclude that Mastery and Control at Work seemed to work as protective factors, while Sense of Moral Burden and perceptions of Angry and Aggressive Behavior made the nursing staff more vulnerable to Stress of Conscience. Future research should investigate whether measures to increase the level of perceived control and being part of decision making will decrease the level of Stress of Conscience among the staff. (shrink)

Background:Nurses frequently face ethically demanding situations in their work, and these may lead to stress of conscience. Working life is currently accelerating and job demands are intensifying. These intensified job demands include (1) work intensification, (2) intensified job-related planning demands, (3) intensified career-related planning demands, and (4) intensified learning demands. At the same time, many healthcare organizations are implementing major organizational changes that have an influence on personnel.Aim:The aim of the study was to investigate the association between intensified (...) job demands and stress of conscience, and whether their association is moderated by organizational change experiences among nurses. Experiences of organizational change may expose employees to stress of conscience or serve as a buffer because employees appraise, involve, and cope with changes differently.Research design:Questionnaires measuring stress of conscience, intensified job demands, and organizational change experiences were completed by nurses (n = 511) in a healthcare district undergoing a major organizational change.Ethical considerations:Throughout, the study procedures were implemented according to the guidelines of the Finnish National Board on Research Integrity and the 1964 Helsinki Declaration and its later amendments. According to the Finnish regulations, because participation was voluntary, informed consent was requested, and participants were advised of their right to withdraw from the study at will. No permission from an ethics committee was necessary.Findings:Work intensification and personal worry considering organizational change were associated with more severe stress of conscience among nurses. Nurses’ experiences of managements’ competent handling of organizational change buffered the association between work intensification and stress of conscience.Conclusions:During organizational changes, management may alleviate nurses’ stress of conscience by proper communication and support procedures. (shrink)

The aim of this observational longitudinal cohort study was to describe relationships over time between degrees of stress of conscience, perceptions of conscience, burnout scores and assessments of person-centred climate and social support among healthcare personnel working in municipal care of older people. This study was performed among registered nurses and nurse assistants (n = 488). Data were collected on two occasions. Results show that perceiving one’s conscience as a burden, having feelings of emotional exhaustion and (...) depersonalization and noticing disturbing conflicts between co-workers were positively associated with stress of conscience. No significant changes were observed during the year under study, but degrees of stress of conscience and burnout scores were higher than in previous studies, suggesting that downsizing and increased workloads can negatively affect healthcare personnel. Following and expressing one’s conscience in one’s work, and perceiving social support from superiors are of importance in buffering the effects of stress of conscience. (shrink)

Every day situations arising in health care contain ethical issues influencing care providers' conscience. How and to what extent conscience is influenced may differ according to how conscience is perceived. This study aimed to explore the relationship between perceptions of conscience and stress of conscience among care providers working in municipal housing for elderly people. A total of 166 care providers were approached, of which 146 (50 registered nurses and 96 nurses' aides/enrolled nurses) completed (...) a questionnaire containing the Perceptions of Conscience Questionnaire and the Stress of Conscience Questionnaire. A multivariate canonical correlation analysis was conducted. The first two functions emerging from the analysis themselves explained a noteworthy amount of the shared variance (25.6% and 17.8%). These two dimensions of the relationship were interpreted either as having to deaden one's conscience relating to external demands in order to be able to collaborate with coworkers, or as having to deaden one's conscience relating to internal demands in order to uphold one's identity as a `good' health care professional. (shrink)

Stress in health care is affected by moral factors. When people are prevented from doing ‘good’ they may feel that they have not done what they ought to or that they have erred, thus giving rise to a troubled conscience. Empirical studies show that health care personnel sometimes refer to conscience when talking about being in ethically difficult everyday care situations. This study aimed to construct and validate the Stress of Conscience Questionnaire (SCQ), a nine-item (...) instrument for assessing stressful situations and the degree to which they trouble the conscience. The items were based on situations previously documented as causing negative stress for health care workers. Content and face validity were established by expert panels and pilot studies that selected relevant items and modified or excluded ambiguous ones. A convenience sample of 444 health care personnel indicated that the SCQ had acceptable validity and internal consistency (Cronbach’s alpha exceeded 0.83 for the overall scale). Explorative factor analysis identified and labelled two factors: ‘internal demands’ and ‘external demands and restrictions’. The findings suggest that the SCQ is a concise and practical instrument for use in various health care contexts. (shrink)

Background In long-term care, registered nurses and other care providers often experience tensions between ideals and realities in the delivery of services, which can result in stress of conscience. Burnout, low quality of care and a tendency to leave the profession are perceived as consequences. Objectives This study aimed to identify the socio-demographic and work-related factors associated with a high level of stress of conscience, particularly between nursing occupations. Research design A cross-sectional survey was conducted among (...) care providers who worked in Norwegian nursing homes and home care services in the spring of 2021. The sample consisted of 950 registered nurses and 1143 other care providers. Data were collected online using the Stress of Conscience Questionnaire (SCQ). Ethical considerations Participation was voluntary and based on consent. The study was approved by the Norwegian Center for Research Data. Results Registered nurses were nearly twice as likely to report high levels of stress of conscience compared to other care providers in long-term care. In addition, being a female, living alone, caring for their own children, working in an institution (versus home based), working >75% time, working shifts, not having scheduled meetings for ethical reflection and working in municipalities with a higher population density were factors associated with a high level of SCQ score. Discussion Knowledge of factors that increase the risk of high SCQ scores in registered nurses provides opportunities for prevention. Managers in long-term care should pay more attention to how work is distributed between the occupational groups and should facilitate real opportunities for ethical reflection. Conclusions The results of this study show that registered nurses have particular exposure to high levels of stress of conscience compared to other care providers in long-term care. Particular attention should be paid to registered nurses working in nursing homes. (shrink)

The Perceptions of Conscience Questionnaire (PCQ) and the Stress of Conscience Questionnaire (SCQ) have previously been developed and validated within the ‘Stress of Conscience Study’. The aim was to revalidate these two questionnaires, including two additional, theoretically and empirically significant items, on a sample of healthcare personnel working in direct contact with patients. The sample consisted of 503 healthcare personnel. To test variation and distribution among the answers, descriptive statistics, item analysis and principal component analysis (...) (PCA) were used to examine the underlying factor structure of the questionnaires. Support for adding the new item to the PCQ was found. No support was found for adding the new item to the SCQ. Both questionnaires can be regarded as valid for Swedish settings but can be improved by rephrasing some of the PCQ items and by adding items about private life to the SCQ. (shrink)

Although organizational and situational factors have been found to predict burnout, not everyone employed at the same workplace develops it, suggesting that becoming burnt out is a complex, multifaceted phenomenon. The aim of this study was to elucidate perceptions of conscience, stress of conscience, moral sensitivity, social support and resilience among two groups of health care personnel from the same workplaces, one group on sick leave owing to medically assessed burnout (n = 20) and one group who (...) showed no indications of burnout (n = 20). The results showed that higher levels of stress of conscience, a perception of conscience as a burden, having to deaden one’s conscience in order to keep working in health care and perceiving a lack of support characterized the burnout group. Lower levels of stress of conscience, looking on life with forbearance, a perception of conscience as an asset and perceiving support from organizations and those around them (social support) characterized the non-burnout group. (shrink)

Background: Troubled conscience among nurses and other healthcare workers represents a significant contributor to healthcare worker moral distress, burnout and attrition. While research in this area has examined critical care in hospitals, less knowledge has been obtained from long-term care contexts such as nursing homes, despite widely recognised challenges with regard to vulnerable patients, increasing workload and maintaining workforce sustainability among nurses. Objective: The aim of this study was to illuminate and interpret the meaning of the lived experience of (...) troubled conscience among registered nurses (RNs) working in nursing homes. Research design: This qualitative research employed narrative interviews with eight nurses to obtain essential meanings of their lived experiences of troubled conscience. The interview texts were analysed using a phenomenological hermeneutic approach. Ethical considerations: Participation was voluntary, informed and was conducted with written consent. The Norwegian Centre for Research Data approved the data processing of personal data. Findings: The analysis uncovered two themes: (1) troubled conscience means abandoning ideals, with the subthemes: failing dependent patients; being disloyal to colleagues; being inadequate in the performance of work tasks and (2) troubled conscience means facing realities, with the subthemes: accepting being part of the system; responding to barriers. Discussion: Troubled conscience meant experiencing continuous and simmering tension between one’s ideals and realities and feeling a drive to preserve accountability and one’s moral integrity. Endangered ideals were often under cross-pressure and included humanistic values, professional values, working life values and the values of the organisation. Conclusion: Nurses’ troubled conscience refers to a struggle, but also a force that plays out at various levels and arenas in long-term care. Openness and dialogue about how professional values and the welfare state’s intentions can be realised within the given framework are important for individual nurses’ occupational health as well as the quality of care provided to patients. (shrink)

BackgroundPublic Safety Personnel are routinely exposed to human suffering and need to make quick, morally challenging decisions. Such decisions can affect their psychological wellbeing. Participating in or observing an event or situation that conflicts with personal values can potentially lead to the development of moral injury. Common stressors associated with moral injury include betrayal, inability to prevent death or harm, and ethical dilemmas. Potentially psychologically traumatic event exposures and post-traumatic stress disorder can be comorbid with moral injury; however, moral (...) injury extends beyond fear to include spiritual, cognitive, emotional or existential struggles, which can produce feelings of severe shame, guilt, and anger.ObjectiveThis scoping review was designed to identify the extant empirical research regarding the construct of moral injury, its associated constructs, and how it relates to moral distress in firefighters, paramedics, and police officers.MethodsA systematic literature search of peer-reviewed research was conducted using databases MEDLINE, EMBASE, APA PsychInfo, CINHAL PLUS, Web of Science, SCOPUS, and Google Scholar. Included studies were selected based on the inclusion criteria before being manually extracted and independently screened by two reviewers.ResultsThe initial database search returned 777 articles, 506 of which remained after removal of duplicates. Following review of titles, abstracts, and full texts, 32 studies were included in the current review. Participants in the articles were primarily police officers, with fewer articles focusing on paramedics and firefighters. There were two studies that included mixed populations. Most studies were qualitative and focused on four topics: values, ethical decision-making, organizational betrayal, and spirituality.ConclusionPublic safety organizations appear to recognize the experience of moral distress or moral injury among public safety personnel that results from disconnects between personal core values, formal and informal organizational values, vocational duties, and expectations. Further research is needed to better understand moral distress or moral injury specific to public safety personnel and inform training and treatment in support of public safety personnel mental health. (shrink)

In lieu of an abstract, here is a brief excerpt of the content:Journal of the History of Ideas 65.3 (2004) 455-474 [Access article in PDF] "Conscience the Ground of Consciousness": The Moral Epistemology of Coleridge's Aids to Reflection Jeffrey Hipolito Everett Community College. It will hardly come as a shock to the readers of this journal that Kant has been the philosophical gatekeeper of all those who have come after him and that the scale of his achievement was recognized (...) even by his immediate peers and the generation which followed them.1 It may be rather more surprising that Samuel Taylor Coleridge belongs among the most interesting members of that second generation, comparable to Fichte, Schelling, Schopenhauer, and Hegel in the originality of his response—not because of the Biographia Literaria (1817), the book for which he is now most famous, but because of the stream of work that followed the publication of the revised Friend (1818). Though the Collected Coleridge project has made available a mass of previously unpublished material, which in turn has stimulated a great deal of interesting research, one must still agree with Elinor Shaffer's recent assessment that "we have no accurate or adequate conception of the late Coleridge from 1819 to his death in 1834."2 Shaffer's range of dates is not accidental, indicating that the revised [End Page 455] Friend (and, more specifically, the break with Schelling) marks the beginning of the "late" Coleridge. In the "Essays on Method" that were a part of the revised Friend (1818) Coleridge effectively freed himself of Schelling's Idealism, which is so notoriously crucial to philosophical chapters of the Biographia, by moving away from the latter's metaphysics of the Absolute towards a metaphysics grounded in an ongoing and in principle unending exploration of "inquiry" itself.3 Though it did not appear until 1825, Aids to Reflection was the first book published by Coleridge following the revised Friend. It was his most popular and influential work during the nineteenth century, but it has been read almost exclusively in strictly theological terms. The implicit contention that the "middle" Coleridge of the Biographia was philosophical and that the "late," post-Biographia Coleridge turned to theology as a refuge from the Biographia's failure was ratified by Thomas McFarland's classic argument concerning the late Coleridge's "trinitarian resolution" to the problems that the middle Coleridge could not solve.4 One pernicious effect of this view (which is more nuanced than I have presented it here) is that until fairly recently it was still possible to describe Aids to Reflection as simply "an effort to argue away the terrifying import of The Ancient Mariner, which would lead us, since it jars our moral feelings, to hatred of God."5I argue in this essay that although Aids to Reflection employs theological vocabulary it is more than—indeed, cannot rightly be considered—an exercise in dogmatic Christian apologetics. More specifically, I will show that the book includes a vigorous engagement with Kant's moral philosophy not primarily by undercutting the metaphysical basis of the critical project's architectonic, though this is an ancillary effect, but by putting pressure on the model of judgment that underlies Kantian ethics.The importance of Kant to Coleridge's intellectual development is not a secret. Coleridge himself describes the way Kant "took possession of me as [End Page 456] with a giant's hand," though he confesses he "could never believe it was possible for him to have meant no more by his Noumenon, or THING IN ITSELF, than his mere words express" and that he even "entertained doubts likewise, whether in his own mind, he even laid all the stress, which he appears to do on the moral postulates."6 Kant's impact on Coleridge was primarily due to his status as a logician and a moral philosopher. Thus Coleridge contends in a letter of 1820 that "Kant will demonstrate to you, that this [Christian] Faith is... grounded on Postulates authorized & substantiated solely by the Moral Being,"7 and adds in another letter five years later that he... (shrink)

The philosophical understanding of moral conscience should constitute one of the most significant concerns of any modern theory of moral education that wishes to be credible and reliable in all morally demanding situations. The purpose of this paper is not to contest the widely accepted notion of conscience as the absolute mark of our moral and spiritual integrity. The purpose of the paper is to postulate and stress the importance of certain "contextual" factors without which modern teaching (...) of moral conscience could very easily lose its certainty and significance. It is argued that unless we make such assumptions, our following the dictates of individual conscience could become a trivial and redundant affair, because nothing could prove that this act is something more than "listening to one's inner voice". In the light of this, the paper proposes a qualified theory that avoids looking at individual conscience as a formal schema and embraces it within the broader framework of the educational demands raised by modern democratic culture. (shrink)

Research on ethical dilemmas in health care has become increasingly salient during the last two decades resulting in confusion about the concept of moral distress. The aim of the present paper is to provide an overview and a comparative analysis of the theoretical understandings of moral distress and related concepts. The focus is on five concepts: moral distress, moral stress, stress of conscience, moral sensitivity and ethical climate. It is suggested that moral distress connects mainly to a (...) psychological perspective; stress of conscience more to a theological–philosophical standpoint; and moral stress mostly to a physiological perspective. Further analysis indicates that these thoughts can be linked to the concepts of moral sensitivity and ethical climate through a relationship to moral agency. Moral agency comprises a moral awareness of moral problems and moral responsibility for others. It is suggested that moral distress may serve as a positive catalyst in exercising moral agency. An interdisciplinary approach in research and practice broadens our understanding of moral distress and its impact on health care personnel and patient care. (shrink)

There are widely differing accounts of Augustine's place in the early history of the notion of conscience. While some regard his contribution as groundbreaking, others consider that he only stressed interiority more than earlier authors. Starting with a contrast with Jerome, the present article aims at clarifying Augustine's specific contribution and the place of conscience in his moral thought.

Pseudo-appeals to conscience stress that the dictates of conscience are always either morally obligatory or at least not morally wrong. These appeals are untenable. They result in an indefensible moral relativism. They should be abandoned.

In lieu of an abstract, here is a brief excerpt of the content:Convention for Protection of Human Rights and Dignity of the Human Being with Regard to the Application of Biology and Biomedicine: Convention on Human Rights and BiomedicineCouncil of EuropePreambleThe Member States of the Council of Europe, the other States and the European Community signatories hereto,Bearing in mind the Universal Declaration of Human Rights proclaimed by the General Assembly of the United Nations on 10 December 1948;Bearing in mind the (...) Convention for the Protection of Human Rights and Fundamental Freedoms of 4 November 1950;Bearing in mind the European Social Charter of 18 October 1961;Bearing in mind the International Covenant on Civil and Political Rights and the International Covenant on Economic, Social and Cultural Rights of 16 December 1966;Bearing in mind the Convention for the Protection of Individuals with Regard to Automatic Processing of Personal Data of 28 January 1981;Bearing also in mind the Convention on the Rights of the Child of 20 November 1989;Considering that the aim of the Council of Europe is the achievement of a greater unity between its members and that one of the methods by which that aim is to be pursued is the maintenance and further realisation of human rights and fundamental freedoms;Conscious of the accelerating developments in biology and medicine;Convinced of the need to respect the human being both as an individual and as a member of the human species and recognising the importance of ensuring the dignity of the human being; [End Page 277]Conscious that the misuse of biology and medicine may lead to acts endangering human dignity;Affirming that progress in biology and medicine should be used for the benefit of present and future generations;Stressing the need for international co-operation so that all humanity may enjoy the benefits of biology and medicine;Recognising the importance of promoting a public debate on the questions posed by the application of biology and medicine and the responses to be given thereto;Wishing to remind all members of society of their rights and responsibilities;Taking account of the work of the Parliamentary Assembly in this field, including Recommendation 1160 (1991) on the preparation of a Convention on bioethics;Resolving to take such measures as are necessary to safeguard human dignity and the fundamental rights and freedoms of the individual with regard to the application of biology and medicine;Have agreed as follows:Chapter IGeneral provisionsArticle 1. (Purpose and object)Parties to this Convention shall protect the dignity and identity of all human beings and guarantee everyone, without discrimination, respect for their integrity and other rights and fundamental freedoms with regard to the application of biology and medicine.Each Party shall take in its internal law the necessary measures to give effect to the provisions of this Convention.Article 2. (Primacy of the human being)The interests and welfare of the human being shall prevail over the sole interest of society or science.Article 3. (Equitable access to health care)Parties, taking into account health needs and available resources, shall take appropriate measures with a view to providing, within their jurisdiction, equitable access to health care of appropriate quality. [End Page 278]Article 4. (Professional standards)Any intervention in the health field, including research, must be carried out in accordance with relevant professional obligations and standards.Chapter IIConsentArticle 5. (General rule)An intervention in the health field may only be carried out after the person concerned has given free and informed consent to it.This person shall beforehand be given appropriate information as to the purpose and nature of the intervention as well as on its consequences and risks.The person concerned may freely withdraw consent at any time.Article 6. (Protection of persons not able to consent)1. Subject to Articles 17 and 20 below, an intervention may only be carried out on a person who does not have the capacity to consent, for his or her direct benefit.2. Where, according to law, a minor does not have the capacity to consent to an intervention, the intervention may only be carried out with the authorisation of his or her representative or an authority or a person or... (shrink)

In Western thought, it has been persistently assumed that in moral and political matters, people should rely on the inner voice of conscience rather than on external authorities, laws, and regulations. This volume investigates this concept, examining the development of the Western politics of conscience, from Socrates to the present, and the formation of the Western ethico-political subject. The work opens with a discussion of the ambiguous role of conscience in politics, contesting the claim that it is (...) the best defense against totalitarianism. It then look back at canonical authors, from the Church Fathers and Luther to Rousseau and Derrida, to show how the experience of conscience constitutes the foundation of Western ethics and politics. This unique work not only synthesizes philosophical and political insights, but also pays attention to political theology to provide a compelling and innovative argument that the experience of conscience has always been at the core of the political Western tradition. An engaging and accessible text, it will appeal to political theorists and philosophers as well as theologians and those interested in the critique of the Western civilization. (shrink)

The book is divided into three parts. The first criticizes in some detail the various naturalistic theories as they appear in philosophy and the sciences. Thus Professor Vivas reckons with the interest theory of Santayana and R. B. Perry, the postulational theory of Charner Perry, the instrumentalist theory of Dewey, the linguistic theory of Stevenson, and again, the cultural relativity of the anthropologists and the genetic account of conscience in Freud. Once these are demolished, the second part looks for (...) the generic structure of the moral experience as focussed in the process of resolving a moral perplexity. Professor Vivas stresses the role of a hierarchically organized system of values espoused by the self which constitutes the person, and repeatedly insists on the objective or "ontic" status of the values. The person is regarded as an axiological not a psychological category; and it is only through resolving moral perplexities that a man finds out, by creating, what he is. The creative element prevents moral decision from being simply self-expression. In fact, the ethical stage, as distinguished from the moral, is characterized by the overthrow of a man's dominant values: "when we repudiate our constitutive values altogether and forge an entirely new personality, a naked, empty self must do the choosing, and how this process is possible is not at all obvious". The third part presents the rise of the ethical attitude in this second birth. Its essence lies in the absolute sanctity of the person, and Professor Vivas sees this as the answer to the conflict of values in our time. (shrink)

This book surveys the major thinking about Christian ethics as found in books published or distributed in the United States from the mid-sixties to the end of the seventies. In the first half of the book, Professor Long updates the analysis he first expounded in 1967 in his widely praised study, A Survey of Christian Ethics. Part one examines the literature dealing with moral reasoning, thinking about laws and codes, and ethics done in terms of situations and relationships. Part two (...) examines published work that stress the importance of institutions, politics in operational terms, and efforts to think of Christian fidelity as expressed in special communities outside or opposed to the civic mainstream. In part three Professor Long examines works concerned with the nature and function of the moral agent, covering such topics as attention to virtue and character, the nature and role of conscience, and thinking about the implications of moral development theory. Part four describes three new frameworks for doing ethics that have been developed during the last fifteen years: vocational ethics and policy studies; liberation theology; and comparative religious ethics. (shrink)

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. (shrink)

Thomistic ethics has sometimes been accused of being excessively rationalistic, impersonal, and a priori. This study attempts to provide textual support from Aquinas for an interpretation which stresses the primacy of conscience, individual responsibility, and the central importance of the virtue of prudence. The doctrine seems timely and suggestive, but the author's decision to write in scholastic jargon limits the effectiveness of this book for the uninitiated.--D. D. O.

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. (shrink)

In lieu of an abstract, here is a brief excerpt of the content:Guibert of Tournai's Letter to Lady Isabelle:An Introduction and English TranslationLarry F. Field, Jacques Dalarun, Sean L. Field, and Guibert of TournaiIntroductionGuibert, from the noble family of As-Piès, was born near Tournai around 1200. From his hometown he traveled to Paris for his art degree, and completed the curriculum in theology there before entering the Franciscan Order around 1240. He may have participated in Louis IX's crusade of 1248, (...) but, if so, was surely back in Paris by 1254 at the latest, since he preached a cycle of sermons de dominicis et de sanctis to the university community before summer 1255.1 His regency as Franciscan master of theology at Paris was probably around 1259–1261,2 about the time he [End Page 31] completed his Eruditio regum et principum for Louis IX,3 and began his most substantial work, the Erudimentum doctrinae.4 Other significant treatises include his De pace et animi tranquillitate (ca. 1275)5 written for Marie de Dampierre, and the Collectio de scandalis ecclesiae, prepared for the Second Council of Lyon.6 Guibert died in Tournai on 7 October 1284.7Sometime around 1254, Guibert wrote a long letter of spiritual advice to Isabelle (1225–70), the sister of King Louis IX.8 Isabelle was herself a remarkable figure. She had rejected several proposals of marriage, including that with Conrad, the heir to Emperor Frederick II, in 1243, in spite of pressure from her family and Pope Innocent IV. But following a bout of serious illness at about that time,9 her family accepted her [End Page 32] decision to remain unwed. There is no evidence, however, that Isabelle ever pronounced a formal vow of virginity. Through the 1250s she simply remained at the Capetian court as a virgin princess with an increasing reputation for piety and indeed holiness, praised in lavish terms by Innocent IV in 1253 and Alexander IV in 1256.10 This piety took a distinctly Franciscan turn by 1254, when Pope Innocent IV granted her request for Franciscan confessors,11 which would ultimately result in her foundation of Longchamp, a house of Sorores minores just west of Paris, by 1260.12 Guibert's letter shows no awareness of such a project, indicating that it must have been written before spring 1255, by which time the land for Longchamp was being purchased on Isabelle's behalf.13 Guibert thus wrote at the moment when Isabelle was forming her first ties to the Franciscans, but well before her move to Longchamp, where she lived out the 1260s as resident lay patron (but never a nun).Guibert's Letter is really a short treatise of spiritual and moral advice, tailored to a celibate princess. It is organized around Psalm 44:14–15, All the glory of the king's daughter is within in golden fringes, clothed around with varieties. In a five-part structure, the king's daughter stands for a heavenly inheritance; glory within represents internal purity; gold indicates virginity; the fringes are a sign of humility; and clothed around with varieties points to honest comportment. The resulting "royal garment," however, is rather unequally woven together, with section one on the "heavenly inheritance" and the intertwined sections three and four on virginity and humility receiving by far the most space. In fact, section one forms a sort of treatise-within-a-treatise, organized as a ten-step ascent to the heavenly inheritance awaiting the daughter of the king. [End Page 33]The Letter to Lady Isabelle was first edited by Alphonse de Poorter in 1931, from a manuscript which contained only part of the text.14 The full text was brought into print by Sean Field in 2003,15 and translated into French by Jacques Dalarun in 2014.16 Yet in spite of these advances, the Letter has remained little noticed by scholars. Anne-Hélène Allirot offered several perceptive pages in 2010, stressing the way Guibert's treatment of hereditas implies that female members of the royal family might be particularly able to embody Capetian claims to holiness.17 That same year, in the only recent article dedicated specifically to this Letter, Rina Lahav... (shrink)

This article indicates the light that an epistemology like Newman’s, with its stress on the convergence of probabilities, the experience of conscience, and the presence of grace, can shed on the problem of faith and reason. The longstanding controversy over this problem between evidentialists and fideists has found new echoes in recent disputes between foundationalists and nonfoundationalists. It is necessary to distinguish between different aspects of the approach to faith—-the metaphysical, the historical, the religious, and the theological—-each with (...) its own logic and distinct style of epistemology. Examination of these aspects indicates that neither evidentialism nor fideism, neither foundationalism nor nonfoundationalism, does justice to the complexity of the matter. Faith arises out of a process in which human reason, in a large and comprehensive sense, is involved at every step of the way. Faith is not above or beyond reason, even though it depends for its origin and existence upon the grace of God. (shrink)

Martin Luther King, Jr., has been widely studied as a preacher, an activist, and an orator, but rarely as an intellectual. This groundbreaking book situates King as one of the most important social and political philosophers of our time, arguing that King's systematic logic of nonviolence is at the same time radically new and deeply rooted in African American intellectual history. Presenting a comprehensive genealogy of King's thought, Moses traces the influence of key African American thinkers and shows how King's (...) concepts of equality, structure, direct action, love, and justice can be seen as strands of a coherent philosophical whole. [As of Feb. 2014 the author has secured reversion of copyright from the publisher.]. (shrink)

Certain philosophers have argued in favour of recognising a right to freedom of conscience that includes a defeasible right of individuals to live in accordance with their perceived moral duties. This right requires the government to exempt people from general laws or regulations that prevent them from acting consistently with their perceived moral duties. The importance of protecting individuals’ integrity is sometimes invoked in favour of accommodating conscience. I argue that personal integrity is valuable since autonomy, identity and (...) self-respect are all dependent on the preservation of personal integrity. I respond to two objections, one pressed by Andrew Koppelman and the other by Richard Arneson, to the claim that personal integrity is valuable, and to a further argument by Arneson to the effect that it is unfair to others claiming accommodations to exempt those with conscience-based claims. (shrink)

This paper addresses the question of whether the interest liberal societies have in producing liberal citizens gives liberal societies the right to regulate the affairs of illiberal groups. It claims that attempts by Rawls and Galston to make liberalism more “pluralism friendly” by reducing the demands for liberal citizenship fail, and it explores arguments by Amy Gutmann, Susan Moller Okin, Eamonn Callan and Will Kymlicka that support a stronger interest in regulating the socialization practices of illiberal groups. The main conclusion (...) of the article is that we must seek for a context-sensitive balance between the need to produce liberal citizens and other liberal values such as freedom of conscience. (shrink)

The great critic Peter Viereck, in a volume that both reproduces an earlier effort and presents an entirely new work on the intersection of history and literature, offers a biting critique of the American desire for normalcy that leads to a culture of the surrender of personality. In contrast to this voluntary thought control process is the unadjusted person. Cast in the mold of great individualists from Thomas More to Friedrich Nietzsche, such a person responds to fundamental values of (...) class='Hi'>conscience rather than conformity built exclusively on ego gratification and icon worship. Viereck's book is a stinging critique of the liberal presumption of a monopoly in critical thought. He argues to the contrary, that most varieties of liberal expression offer little else than the common platitude dressed up as critique. In such a cultural environment, conservatism is the skeleton in the liberal closet. The virtue of conservatism is that in its very stress on liberty as dependent on tradition and law, it permits the human being an opportunity to test all transient things by the touchstone of all lasting ideas. Unadjusted Man cuts deep and in many directions: against left totalitarian regimes of Europe and right wannabes like McCarthyism in America. For Viereck, the art of conserving is not an embrace of utopias to come or empires that were, but retaining the sense of individuality over against the senselessness of the "massman." Civil liberties in this approach are a right to non-conspiratorial dissent informed by fundamental values. The new material is presented unabashedly--without an attempt to rewrite personal history, and with an admission that not every prediction made in the original edition has come to fruition. That said, the underlying themes of the original are not so much repeated as expanded upon. For those seeking a work in the classic mold of conservatism, rather than the strident reactionary views that have come to dominate much of the conservative dialogue, this will be a special book, a special entrance to the mind of a great figure in American culture wars of present as well as past. (shrink)

Background: Limited knowledge of the experiences of conflicts of conscience found in nursing literature. Objectives: To explore the individual experiences of a conflict of conscience for neonatal nurses in Alberta. Research design: Interpretive description was selected to help situate the findings in a meaningful clinical context. Participants and research context: Five interviews with neonatal nurses working in Neonatal Intensive Care Units throughout Alberta. Ethical consideration: Ethics approval from the Health Research Ethics Board at the University of Alberta. Findings: (...) Three common themes emerged from the interviews: the unforgettable conflict with pain and suffering, finding the nurse’s voice, and the unique proximity of nurses. Discussion and conclusion: The nurses described a conflict of conscience when the neonate in their care experienced undermanaged pain and unnecessary suffering. During these experiences, they felt guilty, sad, hopeless, and powerless when they were unable to follow their conscience. Informal ways to follow their conscience were employed before declaration of conscientious objection was considered. This study highlights the vital importance of respecting a conflict of conscience to maintain the moral integrity of neonatal nurses and exposes the complexities of conscientious objection. (shrink)

Moral moments -- The neurotic and the penitent -- True, false, and feigned penance -- Fame without conscience -- Cain and conscience -- Feminine paradoxes -- Sincere hypocrisy -- The poetical consience -- Envoi : spiritual sophistry.

In lieu of an abstract, here is a brief excerpt of the content:Reviewed by:Anthropocentrism and Its Discontents: The Moral Status of Animals in the History of Western PhilosophyRalph AcamporaGary Steiner. Anthropocentrism and Its Discontents: The Moral Status of Animals in the History of Western Philosophy. Pittsburgh: University of Pittsburgh Press, 2005. Pp. ix + 332. Cloth, $37.50.In this text Steiner surveys the (Eurocentric) history of doctrines, attitudes, and beliefs about the ethical standing of (nonhuman) animals. Unsurprisingly, he finds that the (...) mainstream of thought in this area manifests "an underlying logic: that all and only human beings are worthy of moral consideration, because all and only human beings are rational and endowed with language" (2). This neatly expresses the anthropocentrism identified in the book's title, the "discontents" of which are obviously a gloss on Freud's reading of civilization—that is to say, Steiner sees a great deal of dissatisfaction (largely misgivings of conscience) mixed in with our sense of superiority over other animals. Subliminal unease with, and even explicit dissent from, the mainstream orthodoxy is not absent from the [End Page 480] historical account—indeed, as the author rightly indicates, there has been a parallel (if comparatively minor) stream of more animal-friendly philosophy throughout the ages of thinking on this subject. Moreover, this latter current of thought has been gathering strength lately as "an increasing number of ethologists and philosophers have marshaled insights concerning the evolutionary continuity and physiological similarity between animals and human beings to argue that many animals are conscious, sentient beings that [or better, who] deserve substantial moral consideration" (3).From the outset, then, Steiner situates his historical project within the context of contemporary debates in animal ethics. "By focusing on the historical development of thinking about animals," he proposes, "one can understand the sources of our own anthropocentric prejudices and use that history as the basis for a radical rethinking of the moral status of animals" (37). Early on, in the first chapter in fact, Steiner identifies two problems in the current development of the heterodox, animal-friendly tradition: animal ethicists, he claims, tend to overestimate the mental faculties of nonhumans and do not question the longstanding assumption that intellect (rational or linguistic) is what ultimately imparts moral significance. In effect, Steiner's charge is that these moralists anthropomorphize animals psychologically because they are still tied (critical protestations notwithstanding) to ethical anthropocentrism.Even aside from his ambition to further contemporary animal ethics, Steiner has provided a needed and lucid account of the history he targets. The historical surveys of animal ethics already on the record are limited either because they are merely brief preludes to anthologies or monographs whose main interest is to theorize anew or because they are subsidiary to histories of broader fields such as environmental or ecological thinking. Though Steiner harbors no pretense to exhaustive coverage, the figures he does treat are representative of a fairly comprehensive range from antiquity to postmodernity. Not only are famous vegetarians of the classical Greco-Roman periods covered (viz. Pythagoras, Plutarch, and Porphyry), but arch-anthropocentrists such as Aristotle and the Stoics are examined as well (though in the chapter dedicated to them, one would have liked to see more attention given to the animal-friendly Theophrastus). Notable here is that Steiner treats an assortment of Presocratic philosophers, extending back even to epic thinkers such as Hesiod and Homer. A number of medieval Christians are covered (including Augustine, Francis of Assisi, and Thomas Aquinas), and then it is on to a full chapter about Cartesian thought, before another on empiricism, utilitarianism, and Kant. Last in the survey come a trio of late moderns (Schopenhauer, Darwin, and Schweitzer), followed by a postmodern triumvirate (Heidegger, Levinas, and Derrida). Unfortunately absent from this later coverage are the vitalist Henri Bergson and his post-structuralist heirs, Gilles Deleuze and Felix Guattari.In his final chapter Steiner aims to harness the history he has related for the purpose of reconceiving the moral status of animals so as to avoid the twin problems of anthropocentrism and anthropomorphism which he sees as our inheritance in the Western tradition. The route he takes is to synthesize biocentrically two rival approaches of species linkage, one that stresses common competence and another... (shrink)

This article examines the meaning and role of conscience in the political theology of John Calvin. It argues that the focus in Calvin scholarship on whether conscience makes political order possible without the aid of scripture is misplaced. Although Calvin views conscience as a providential gift that restrains evil to some degree, he puts forth this claim only as part of his defence of God's right to punish all humans eternally. Conscience, that is, renders humans 'inexcusable' (...) before God. Thus, to ask whether conscience makes political order possible in and of itself is to ask a question with which Calvin does not concern himself. Doing so obscures the real significance of conscience for Calvin's political theory: conscience as the starting point for the construction of a Christian polity. The torments of conscience prompt individuals to seek relief, driving them to Christ for salvation and forgiveness of their sins. This, in turn, leads them to submit willingly to the 'external aids' or 'outward helps' of the church and civil government in order to live just and virtuous lives. (shrink)

Resumen: La relevancia del estudio se debe a la necesidad de un análisis conceptual de la transformación de un fenómeno tan humano como la conciencia en el período de los siglos XX-XXI. En este sentido, el propósito de este estudio es determinar las principales características del reflejo de la conciencia en la conciencia pública de los siglos XX - XXI y sus características funcionales clave. Los principales métodos científicos para estudiar el tema son los métodos científicos generales básicos de análisis, (...) síntesis, inducción, deducción, comparativos, sistemáticos, que permiten un acercamiento exhaustivo a la presentación del tema y crean una imagen estructurada de las transformaciones morales y éticas. El artículo revela los enfoques fundamentales de la interpretación de la conciencia en la historiografía moderna. Los resultados de la investigación pueden utilizarse activamente no sólo en la ciencia filosófica moderna, como fundamentación de los principales enfoques para la interpretación de la percepción real de la conciencia, sino también en las humanidades afines para confirmar cambios históricos, morales, éticos, psicológicos y de otro tipo. en el proceso de evolución social. (shrink)

Access to abortion is becoming increasingly restricted for many women in the United States. Besides the longstanding financial barriers facing low-income women in most states, a newer source of scarcity has emerged. The relatively small number of physicians willing to perform the procedure is compromising the ability of women in certain parts of the country to obtain an abortion.Do physicians have a duty to respond to this situation? Do they have a professional responsibility to ensure that abortions are reasonably available (...) to the women who want to terminate their pregnancies? Or, is abortion so morally and socially controversial as to remove any professional obligation to provide reasonable access?Both law and medical ethics have traditionally protected physicians’ freedom to refuse to perform any procedure, including abortion, that conflicts with their religious or other moral beliefs. (shrink)

Access to abortion is becoming increasingly restricted for many women in the United States. Besides the longstanding financial barriers facing low-income women in most states, a newer source of scarcity has emerged. The relatively small number of physicians willing to perform the procedure is compromising the ability of women in certain parts of the country to obtain an abortion.Do physicians have a duty to respond to this situation? Do they have a professional responsibility to ensure that abortions are reasonably available (...) to the women who want to terminate their pregnancies? Or, is abortion so morally and socially controversial as to remove any professional obligation to provide reasonable access?Both law and medical ethics have traditionally protected physicians’ freedom to refuse to perform any procedure, including abortion, that conflicts with their religious or other moral beliefs. (shrink)

In an era of confessional conflict, the conscience served as a powerful mediator between God and man, directing and judging moral actions. This work aims to convey the breadth of the conscience's jurisdiction, analyzing its impact upon a variety of important aspects of early modern society: political allegiance the genre of "advice to princes" religious conformity slavery the regulation of sexual behavior gender roles and the intellectual methods of scientists.

Does a pharmacist have a right to refuse to fill certain prescriptions? In this paper, I examine cases in which an employee might refuse to do something that is part of his or her job description. I will argue that in some of these cases, an employee does have a right of refusal and in other cases an employee does not. In those cases where the employee does not have a right of refusal, I argue that the refusals are just (...) cause for termination of employment. I argue that there are moral principles that support the different outcomes in the cases under consideration. I turn to pharmacy cases at the end of the paper and argue that they are analogous to cases where an employee does not have a right of refusal and thus fall under the principle that refusing to fill birth control prescriptions constitutes just cause for termination. (shrink)

At a historic dialogue convened at the University of Richmond, Virginia, Baptist and secular humanist scholars in theology, history, philosophy, and the social sciences, came together to define shared concerns and common values. The dialogue focused on major areas of concern: academic freedom; social, political, and religious tolerance; biblical scholarship; separation of church and state; the social agenda of the Christian Coalition and the Southern Baptist Convention; the danger of militant fundamentalism; freedom of conscience and the historic and current (...) role of American Baptists; as well as the plight of pluralistic democracy. (shrink)

The influence of conscience on nurses in terms of guilt has frequently been described but its impact on care has received less attention. The aim of this study was to describe nurses' conceptions of the influence of conscience on the provision of inpatient care. The study employed a phenomenographic approach and analysis method. Fifteen nurses from three hospitals in western Sweden were interviewed. The results showed that these nurses considered conscience to be an important factor in the (...) exercise of their profession, as revealed by the descriptive categories: conscience as a driving force; conscience as a restricting factor; and conscience as a source of sensitivity. They perceived that conscience played a role in nursing actions involving patients and next of kin, and was an asset that guided them in their efforts to provide high quality care. (shrink)

Pfeiffer, Kimberley Review of: Conflicts of Conscience in Health Care: An Institutional Compromise, by Holly Fernandez-Lynch, Massachusetts Institute of Technology Press, 2008.

This paper addresses the question of whether the interest liberal societies have in producing liberal citizens gives liberal societies the right to regulate the affairs of illiberal groups. It claims that attempts by Rawls and Galston to make liberalism more “pluralism friendly” by reducing the demands for liberal citizenship fail, and it explores arguments by Amy Gutmann, Susan Moller Okin, Eamonn Callan and Will Kymlicka that support a stronger interest in regulating the socialization practices of illiberal groups. The main conclusion (...) of the article is that we must seek for a context-sensitive balance between the need to produce liberal citizens and other liberal values such as freedom of conscience. (shrink)

While abortion has been legal in most developed countries for many years, the topic remains controversial. A major area of controversy concerns women’s rights vis-a-vis the rights of health professionals to opt out of providing the service on conscience grounds. Although scholars from various disciplines have addressed this issue in the literature, there is a lack of empirical research on the topic. This paper provides a documentary analysis of three examples of conscientious objection on religious grounds to performing abortion-related (...) care by midwives in different Member States of the European Union, two of which have resulted in legal action. These examples show that as well as the laws of the respective countries and the European Union, professional and church law each played a part in the decisions made. However, support from both professional and religious sources was inconsistent both within and between the examples. The authors conclude that there is a need for clear guidelines at both local and pan-European level for health professionals and recommend a European-wide forum to develop and test them. (shrink)

Martin Luther King, Jr. developed a philosophical logic of nonviolence in terms of equality, structure, nonviolent direct action, and love. Here we look at the way King's analysis makes use of each concept with a special view to the context of other Black activist intellectuals. This ebook is a slightly edited version of earlier print editions.