This book argues that a conscientiously objecting medical professional should receive an exemption only if the grounds of an objector's refusal are reasonable. It defends a detailed, contextual account of public reasonability suited for healthcare, which builds from the overarching concept of Rawlsian public reason. The author analyzes the main competing positions and maintains that these other views fail precisely due to their systematic inattention to the grounding reasons behind a conscientious objection; he argues that any such view is plausible (...) to the extent that it mimics the 'reason-giving requirement' for conscience objections defended in this work. Only reasonable objections can defeat the prior professional obligation to assign primacy to patient well-being, therefore one who refuses a patient's request for a legally available, medically indicated, and safe service must be able to explain the grounds of their objection in terms understandable to other citizens within the public institutional structure of medicine. The book further offers a novel policy proposal to deploy the Reasonability View: establishing conscientious objector status in medicine. It concludes that the Reasonability View is a viable and attractive position in this debate. A New Theory of Conscientious Objection in Medicine: Justification and Reasonability will be of interest to researchers and advanced students working in bioethics, medical ethics, and philosophy of medicine, as well as thinkers interested in the intersections between law, medical humanities, and philosophy. (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)

Current mainstream approaches to conscientious objection either uphold the standards of public health care by preventing objections or protect the consciences of health‐care professionals by accommodating objections. Public justification approaches are a compromise position that accommodate conscientious objections only when objectors can publicly justify the grounds of their objections. Public justification approaches require objectors and assessors to speak a common normative language and to this end it has been suggested that objectors should be required to cast their objection in terms (...) of public reason. We provide critical support for such a public reason condition and argue that it would be neither too demanding nor too permissive. We also respond to objections that it unfairly favours secular over religious objectors and that public reasons cannot be held with the kind of sincerity thought to characterize conscientious objections. (shrink)

In this paper I defend the Reasonability View: the position that medical professionals seeking a conscientious exemption must state reasons in support of their objection and allow those reasons to be subject to evaluation. Recently, this view has been criticized by Jason Marsh as proposing a standard that is either too difficult to meet or too easy to satisfy. First, I defend the Reasonability View from this proposed dilemma. Then, I develop this view by presenting and explaining some of the (...) central criteria it uses to assess whether a conscientious objection is proper grounds for extending an exemption to a medical practitioner. (shrink)

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)

This paper builds upon previous work in which I argue that we should assess a provider's reasons for his or her objection before granting a conscientious exemption. For instance, if the medical professional's reasoned basis involves an empirical mistake, an accommodation is not warranted. This article poses and begins to address several deep questions about the workings of what I call a reason-giving view: What standard should we use to assess reasons? What policy should we adopt in order to evaluate (...) the reasons offered by medical practitioners in support of their objections? I argue for a reasonability standard to perform the essential function of assessing reasons, and I offer considerations in support of a policy establishing conscientious objector status in medicine. (shrink)

Rule-consequentialism is frequently regarded as problematic since it faces the following powerful dilemma: either rule-consequentialism collapses into act-consequentialism or rule-consequentialism is inconsistent. Recent defenders of this theory such as Brad Hooker provide a careful response to this objection. By explicating the nature and theoretical commitments of rule-consequentialism, I contend that these maneuvers are not successful by offering a new way of viewing the dilemma which retains its force even in light of these recent discussions. The central idea is that even (...) the most well-developed contemporary form of the view is ensnared in the following dilemma: as an agent-neutral consequentialist theory, rule-consequentialism is either inconsistent or it is desperately unmotivated as a form of consequentialism since it is committed to a non-consequentialist form of ultimate moral value. (shrink)

Actions within organizational contexts should be understood differently as compared with actions performed outside of such contexts. This is the case due to the agentic shift, as discussed by social psychologist Stanley Milgram, and the role that systemic factors play in shaping the available alternatives from which individuals acting within institutions choose. The analysis stemming from Milgram’s experiments suggests not simply that individuals temporarily abdicate their moral agency on occasion, but that there is an erosion of agency within organizations. The (...) point about the erosion of agency is deepened in the discussion of a case study which illustrates the difficulty of identifying even the bare “ownership” of actions within organizations. While this is the case, explicating these reasons suggests that both individual actors and firms can bear ethical responsibility within organizational contexts. As part of the effort to present the whole picture, business ethics courses should introduce students to the relevant insights from social psychology and human factors research. (shrink)

A powerful objection to impersonal moral theories states that they cannot accommodate the good of friendship. This paper focuses on the problem as it applies to consequentialism and addresses the recent criticism that even the most sophisticated forms of consequentialism are incompatible with genuine friendship. I argue that this objection fails since those who pose this challenge either seriously oversimplify consequentialism's theory of value, misunderstand its theory of practical reason, or put too much weight on the good of friendship itself. (...) I conclude by assessing a contemporary consequentialist response in order to suggest a workable conception of consequentialist friendship. (shrink)

Recent survey data gathered from British medical students reveal widespread acceptance of conscientious objection in medicine, despite the existence of strict policies in the UK that discourage conscientious refusals by students to aspects of their medical training. This disconnect demonstrates a pressing need to thoughtfully examine policies that allow conscience objections by medical students; as it so happens, the USA is one country that has examples of such policies. After presenting some background on promulgated US conscience protections and reflecting on (...) their significance for conscience objections by medical students, this paper observes that the dominant approach (following the American Medical Association's conscience clause) is to allow exempted students to instead be evaluated on the basis of alternative curricular activities to learn the associated underlying content. This paper then introduces and discusses an example in which male Muslim students who believe it is wrong to touch members of the opposite sex object to performing physical examinations on female subjects in their medical training. This sort of case, it is argued, causes difficulty for a conscience clause that resolves the dilemma by granting reasonable exemptions in the form of participation in alternative curricular activities: there are cases where one must perform the ‘objectionable’ activity itself in order to learn the necessary content and underlying principles. (shrink)

Ancell and Sinnott-Armstrong argue that medical providers possess wide freedoms to determine the scope of their practice, and therefore, prohibiting almost any conscientious objections is a bad idea. They maintain that we could create an acceptable system on the whole which even grants accommodations to discriminatory refusals by healthcare professionals. Their argument is premised upon applying a free market mechanism to conscientious objections in medicine, yet I argue their Market View possesses a number of absurd and troubling implications. Furthermore, I (...) demonstrate that the fundamental logic of their main argument is flawed. Thinkers who wish to address the issues raised in this debate in general or by discriminatory conscience objections in particular should avoid the Market View and instead envisage theories that assess the reasons underlying conscientious refusals in medicine. (shrink)

Elizabeth Anderson claims that states of affairs are merely extrinsically valuable, since we value them only in virtue of the intrinsically valuable persons in those states of affairs. Since it considers states of affairs to be the sole bearers of intrinsic value, Anderson argues that consequentialism is incoherent because it attempts to globally maximize extrinsic value. I respond to this objection by distinguishing between two forms of consequentialist teleology and arguing that Anderson''s claim is either harmless or her argument for (...) the claim is uncompelling. On the first conception of teleology, consequentialists need not hold that states of affairs are the sole bearers of intrinsic value, which allows them to deflect this criticism. On the second account of teleology, even assuming that states of affairs are the sole bearers of intrinsic value, Anderson''s argument does not necessarily defeat such views. (shrink)

Adopting a critical thinking methodology in which critical thinking tools are introduced and applied to medical ethics reading, this book explains the dialogue which is formed by the readings in each chapter and clarifies how the various thinkers are responding to one another in a common discussion. The books' unified approach offers a critical thinking pedagogy, which philosophically and logically pulls the many readings and philosophies together. The book examines an introduction to moral theory and critical thinking tools, while readings (...) address the following issues: surrogacy contracts; abortion; ethical issues at the end of life; genetics and morality; ethics and HIV/AIDS; the relationship between medical professionals and patients; research on human and non-human subjects; allocation of medical resources and justice issues in health care systems. For individuals interested in medical ethics and philosophy. (shrink)

ABSTRACT Don Marquis argues that abortion is morally wrong in most cases since it deprives the fetus of the value of its future. I criticize Marquis’s argument for the modified conservative view by adopting an argumentative strategy in which I work within his basic account: if it is granted that his fundamental idea is sound, what follows about the morality of abortion? I conclude that Marquis is faced with a dilemma: either his position must shift towards the extreme conservative view (...) on which abortion is never morally permissible, or he must abandon any recognizably conservative view. This dilemma suggests that Marquis’s view is either deeply implausible or that he cannot use this argument to successfully support his preferred position. (shrink)

Mary Anne Warren provides a well‐known defense of the liberal position in the abortion debate, yet her argument is subject to the objection that it implies that infanticide is morally permissible. In a postscript to her original article, Warren argues that her position does not commit her to the moral acceptability of infanticide. I argue that the reasoning Warren presents in her postscript on infanticide undermines her original main argument in support of the liberal view: she cannot use this argument (...) to both defend the liberal view on abortion and establish that infanticide is morally wrong. (shrink)

The situationist challenge to global character traits claims that on the basis of findings in social psychology, we should only accept at most the existence of local or context-sensitive traits. In this article I explore a neglected area of J. S. Mill's work to outline an account of context-sensitive traits. This account of traits, coupled with a sophisticated consequentialist ethical framework, suggests an interesting view on which persons govern the circumstances of their actions in order to best promote overall well-being.

This paper argues that the provider conscience regulation recently put into place in the USA is misguided. The rule is too broad in the scope of protection it affords, and its conception of what constitutes assistance in the performance of an objectionable procedure reveals that it is unworkable in practice. Furthermore, the regulation wrongly treats refusal of other reproductive services as on a par with conscientious objection to participation in abortion. Finally, the rule allows providers to refuse even to discuss (...) “objectionable” options with patients and serves to protect discriminatory refusals of medical care. For all of these reasons, this regulation is unwise. (shrink)

Bernard Williams has argued that on a consequentialist moral theory, individuals cannot possess what he calls "integrity." I argue that one central strand of this criticism concerns how persons must think about life-shaping decisions. I interpret "integrity" as a pattern of continuity in an agent's moral decision-making. In order to have integrity an agent must possess a stable character which unifies one's choices. Since a sophisticated consequentialist moral structure can properly value the having of a character on the basis of (...) which agents guide their lives, it can successfully address this criticism. (shrink)