Are there different spheres of conscience?

Abstract

Interest in understanding the meaning of conscience and conscientious objection in medicine has recently emerged in the academic literature. We would like to contribute to this debate in four ways: (1) to underscore and challenge the existing hierarchy of conscientious objection in health care; (2) to highlight the importance of considering the lay public when discussing the role of conscientious objection in medicine; (3) to critique the numerous proposals put forth in favour of implementing review boards to assess whether appeals to conscience are justifiable, reasonable and sincere; and (4) to introduce the Universal Declaration of Human Rights and the Siracusa Principles into the dialogue around conscience and suggest that perhaps conscientious objection is a human right.

Conciencia moral: ampliando su aplicación en salud. Aspectos teóricos y prácticos de los juicios de conciencia en Chile

“…Parece lógica la posibilidad de actuar en concordancia y, de esta manera, la objeción de conciencia surge como un derecho humano básico (13). Lo anterior no siempre se entiende como tal y se podría argumentar que la libertad de conciencia no necesariamente implica el derecho a objeción de conciencia.…”

Philosophy, ethics, medicine and health care: the urgent need for critical practice

“…This first thematic edition of the Journal devoted explicitly to philosophy in medicine and health care continues this tradition. We present contributions from some of the most incisive, exciting and rigorous thinkers the discipline has to offer on a broad range of subjects of urgent practical import [33–61]. The key goal is to bring depth and clarity to the discussion of topics too often addressed superficially, even in some respected mainstream medical media 3 .…”

“…Two papers address the issue of conscience and conscientious objection with regard to controversial medical practices. Erica Sutton and Ross Upshur critique numerous proposals in favour of implementing review boards to assess whether appeals to conscience are 'justifiable, reasonable, and sincere' [49]. They note that both legal norms and academic work in the area 'reveal a constructed hierarchy of conscientious objections', which they seek to expose and challenge, emphasizing the importance of considering the lay public when discussing the role of conscientious objection in medicine, and using the Universal Declaration of Human Rights and the Siracusa Principles to suggest that 'perhaps conscientious objection is a human right'.…”

An Official American Thoracic Society Policy Statement: Managing Conscientious Objections in Intensive Care Medicine

“…COs include: (1) to protect clinicians' moral integrity, (2) to respect clinicians' autonomy, (3) to improve the quality of medical care, and (4) to identify needed changes in professional norms and practices. However, the accommodation of COs may have negative consequences for patients, colleagues, and institutions.…”

“…However, the accommodation of COs may have negative consequences for patients, colleagues, and institutions. Reasons not to accommodate COs include: (1) to honor core professional commitments, (2) to protect vulnerable patients, (3) to prevent excessive hardships for other clinicians or the institution, and (4) to avoid invidious discrimination.…”