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- Farr A. Curlin (2007). Caution: Conscience is the Limb on Which Medical Ethics Sits. American Journal of Bioethics 7 (6):30 – 32.
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Amputation of a limb can result in the persistent hallucination that the limb is still present [Ramachandran and Hirstein, 1998]. Distressingly, these socalled ‘phantom limbs’ are often quite painful. Of a friend whose arm had been amputated due to gas gangrene, W.K. Livingston writes: I once asked him why the sense of tenseness in the hand was so frequently emphasized among his complaints. He asked me to clench my fingers over my thumb, flex my wrist, and raise the arm into a hammerlock position and hold it there. He kept me in this position as long as I could stand it. At the end of five minutes I was perspiring freely, my hand and arm felt unbearably cramped, and I quit. But you can take your hand down, he said. (quoted in [Melzack, 1973] 53) In addition to the obvious medical issues, phantom limb pain also presents philosophical problems. Here’s a thorny one: are phantom limb pains hallucinations of pain?
What role should the physician's conscience play in the practice of medicine? Much controversy has surrounded the question, yet little attention has been paid to the possibility that disputants are operating with contrasting definitions of the conscience. To illustrate this divergence, we contrast definitions stemming from Abrahamic religions and those stemming from secular moral tradition. Clear differences emerge regarding what the term conscience conveys, how the conscience should be informed, and what the consequences are for violating one's conscience. Importantly, these basic disagreements underlie current controversies regarding the role of the clinician's conscience in the practice of medicine. Consequently participants in ongoing debates would do well to specify their definitions of the conscience and the reasons for and implications of those definitions. This specification would allow participants to advance a more philosophically and theologically robust conversation about the means and ends of medicine.
Machine generated contents note: Preface; 1. Introduction; 2. Three approaches to conscientious objection in health care: conscience absolutism, the incompatibility thesis, and compromise; 3. Ethical limitations on the exercise of conscience; 4. Pharmacies, health care institutions, and conscientious objection; 5. Students, residents, and conscience-based exemptions; 6. Conscience clauses: too little and too much protection; References.
ch. 1. Conscience--the subjective norm of morality -- ch. 2. Conscience and law -- ch. 3. Relationship between conscience and law -- ch. 4. Holy Scipture on the nature of conscience -- ch. 5. Freedom and commitment of conscience -- ch. 6. The African and conscience with particular reference to the Igbos of Nigeria -- ch. 7. Igbo moral conscience in the light of cross-cultural education: Western civilisation and christianity.
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The ethics of medically-authorized limb amputation in individuals with Body integrity identity disorder (BIID) remains extremely controversial. One factor to consider is the putative locus of a disease process, and whether the proposed treatment--in this case, limb amputation—reasonably addresses the issue of what organ is mediating the patient’s complaint.
A growing number of medical professionals claim a right of conscience, a right to refuse to perform any professional duty they deem immoral—and to do so with impunity. We argue that professionals do not have the unqualified right of conscience. At most they have a highly qualified right. We focus on the claims of pharmacists, since they are the professionals most commonly claiming this right.
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