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Abortion: At the Still Point of the Turning Conscientious Objection Debate

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Abstract

Abortion is the central issue in the conscientious objection debate. In this article I demonstrate why this is so for two philosophical viewpoints prominent in American culture. One, represented by Patrick Lee and Robert P. George, holds that the fundamental moral value of being human can be found in bare life and the other, represented by Tom Beauchamp and James Childress, holds that this fundamental value is found in the life that can choose and determine itself. First, I articulate Lee and George’s philosophical theory and demonstrate how the fundamental moral value of their theory, personhood, is represented in the issue of abortion. Second, I examine Beauchamp and Childress’ theoretical vision and demonstrate how their fundamental moral value, the right to autonomous self-determination, is represented in abortion. Third, I sketch the theoretical and practical dynamics of the conscientious objection debate as well as each author’s understanding of conscience. Fourth, I demonstrate how abortion, which represents their respective fundamental value, shapes each perspectives’ approach to the conscientious objection debate. I conclude that because each theory finds its fundamental value represented in the issue of abortion, each perspective is bound to engage the conscientious objection debate in a way that centers on the issue of abortion.

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Notes

  1. I do not think that there is any agreement concerning the content of the concept of ‘conscience’, or ‘a conscience’ in the current American debate. Nonetheless, the term is still widely used. As will be shown, the lack of agreement regarding “the thing often called conscience” is, in important respects, the crux of the conscientious objection debate in the morally pluralistic culture of twenty-first century America. Hence, I will speak of ‘conscience’ noting its lack of widely agreed upon content. Further, while the abortion and conscientious objection debates are not unique to the United States, Charo and Cantor function within American culture to generate their positions. Therefore, in order to provide an analysis as consistent with the authors as possible, my analysis proceeds from the same frame of reference.

  2. While both authors are Roman Catholic their argument for the personhood and value of the human embryo/fetus is philosophical in nature. The unchanging moral teaching of the Church against abortion rests on the belief that fetus’ should be treated with full moral consideration, not on the metaphysical argument that the embryo is a human person. See Connery (1977, pp. 304–313).

  3. Aristotle explains the significance of politics as follows: “Now, since politics uses the rest of the sciences, and since, again, it legislates what we are to do and what we are to abstain from, the end of this science must include those from the others, so that this end must be the good for man. For even if the end is the same for a single man and for a state, that of the state seems at all events something greater and more complete whether to attain or preserve; though it is worthwhile to attain the end for merely one man, it is finer and more godlike to attain it for a nation or for city-states.” See Aristotle (1998, Nicomachean ethics, 1094b6-12).

  4. For example, they explain, “We are by nature members of communities. Our moral goodness or character consists to a large extent (though not solely) in contributing to the communities of which we are members. We ought to act for our genuine good or flourishing (we take that as a basic ethical principle), but our flourishing involves being in communion with others. And communion with others of itself—even if we find ourselves united with others because of a physical or social relationship which precedes our consent—entails duties or responsibilities. Moreover, the contribution we are morally required to make to others will likely bring each of us some discomfort and pain. This is not to say that we should simply ignore our own good, for the sake of others. Rather, since what (and who) I am is in part constituted by various relationships with others, not all of which are initiated by my will, my genuine good includes the contributions I make to the relationships in which I participate. Thus, the life we constitute by our free choices should be in large part a life of mutual reciprocity with others” (Lee and George 2005, pp. 22–23).

  5. Beauchamp and Childress make it quite clear, “the fundamental requirement [of the health professional] is to respect a particular person’s autonomous choices, whatever they may be. Respect for autonomy is not a mere ideal in health care; it is a professional obligation. Autonomous choice is a right—not a duty—of patients” (Beauchamp and Childress 2009, p. 107). Also, while B&C hold “consequential decisions must be substantially autonomous,” they also recognize that, “being fully autonomous is a mythical idea” (Beauchamp and Childress 2009, p. 102).

  6. It could also be the case that there is ultimately only a single answer, but, due to epistemic limitations, people have not been able to know which is the very best way to handle conflict situations. However, as it plays out in the American biomedical sphere, differing judgments are made to articulate differing ways of handling conflicts of ‘conscience’: some advocate not squelching the possibility on the front end by not having those with self-identified potential ‘conscience’ conflicts allowed entrance to the profession, while others argue for limited, respectful toleration of ‘conscience’.

  7. Engelhardt presents these options based on the following argument: “Insofar as there is skepticism regarding the ability to discover the morally canonical character of such allocation and/or the ability to derive moral warrants to impose such [health care] allocutions by force, one must derive authority for common actions from negotiation and consent” (Engelhardt Jr. 1991, p. 104).

  8. That is, at least in a culture that derives moral authority from the consent of those involved, which he takes the United Sates to be.

  9. For instance, both Charo and Cantor argue for the limitation of ‘conscience’ exceptions by arguing for a stronger and more robust sense of medical professionalism which includes, as they see it, putting the needs and requests of patients for treatments and services to which they are legally entitled ahead of the personal beliefs of the medical professional.

  10. All quotes in this paragraph taken from American College of Obstetricians and Gynecologists (2007, p. 2).

  11. Most debaters willing to accept the possibility of justified conscientious objection qualify their support by claiming it only applies to genuine claims. However, similarly to concept of ‘conscience’, there appears to be no content-thick, commonly understood meaning of the term ‘genuine claim’. For instance, for ACOG genuine claims would be those that are not merely self-protective, grounding their definition in their vision of the principle of beneficence.

  12. This connection is not limited to abortion but rather includes all cases in which conflicts of ‘conscience’ arise. Thus, the individual’s belief about issue X is the subject of the socio-political debate about conscientious objection.

  13. It may seem that in the realm of public policy formulation the conscientious objection issue holds a primary place for B&C. After all, it deals directly with the ability for self-determination in the public sphere. Indeed, one might argue that the entire debate concerns itself with balancing the capability for self-determination of the physician against the capability for self-determination of the patient. It is under these terms that the principle of beneficence is invoked, usually guiding the physician to limit his or her own capacity for self-determination to those determinations which empower the patient to become more fully capable of self-determination. Objection verification processes, like the military model, are then viewed as tools for determining the proper balance between the self-determination of the physician and the self-determination of the patient on a case-by-case basis. Thus, if the ‘conscience’ claim is not genuine, the patient’s capability for self-determination has been curtailed unjustifiably. This type of curtailing of the capability for self-determination amounts to a mortal sin from the B&C perspective.

  14. This would seem to be an extreme version of the B&C position as it would argue that, for whatever reason, the self-determination of the patient is being limited and that this should only happen to the degree it is justifiable. That is, in his or her very non-performance, the objecting medical professional is violating the principle of beneficence as it is expressed by the standards of the medical profession, which is, serving the patient’s interest over the professionals.

  15. This moral vision assumes that there is an objective truth of the matter, though knowing this truth can often be difficult and incomplete.

  16. Here he places toleration between the extremes of “repressive” and “licentious” societal circumstances.

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Acknowledgment

I would like to thank Griffin Trotter, MD, PhD, without whom this article would not be possible, and my reviewers for their helpful criticism of earlier drafts.

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Correspondence to Elliott Louis Bedford.

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Bedford, E.L. Abortion: At the Still Point of the Turning Conscientious Objection Debate. HEC Forum 24, 63–82 (2012). https://doi.org/10.1007/s10730-011-9156-7

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