Abstract
Increasingly, physicians are being asked to provide technical services that many (in some cases, most) believe are morally wrong or inconsistent with their beliefs about the meaning and purposes of medicine. This controversy has sparked persistent debate over whether practitioners should be permitted to decline participation in a variety of legal practices, most notably physician-assisted suicide and abortion. These debates have become heavily politicized, and some of the key words and phrases are being used without a clear understanding of their meaning. In this essay, I endeavor, firstly, to clarify the meaning of some of these terms: conscience, conscientious action, professional judgment, conscientious objection, conscience clauses, civil disobedience, and tolerance. I argue that use of the term conscientious objection to describe these refusals by health care professionals is mistaken and confusing. Secondly, relying on a proper understanding of the moral and technical character of medical judgment, the optimal deference that the state and markets ought to have toward professions, and general principles of Lockean tolerance for a diversity of practices and persons in a flourishing, pluralistic, democratic society, I offer a defense of tolerance with respect to the deeply held convictions of physicians and other health care professionals who hold minority views on contested but legal medical practices.
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Notes
The notion of conscience is more fully explored in [6].
This discussion of professional judgment draws heavily on [8].
Savulescu and Schuklenk have written: “If a service a doctor is requested to perform is a medical practice, is legal, consistent with distributive justice, requested by the patient or their appointed surrogate, and is plausibly in their interests, the doctor must ensure the patient has access to it. It is then irrelevant how defensible the doctor’s own moral take on the patient’s actions is” [18].
This has actually been done. Although most surgeons, responsibly, refused, the so-called “parrot man” was able to find a surgeon who would cut off his earlobes to make him look like a bird, which the patient thought was in his best interest [22].
That is, of course, unless very recent studies showing that LSD might be effective in treating post-traumatic stress disorder and other psychiatric conditions prove that it is safe and effective for such indications [25].
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Sulmasy, D.P. Conscience, tolerance, and pluralism in health care. Theor Med Bioeth 40, 507–521 (2019). https://doi.org/10.1007/s11017-019-09509-5
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DOI: https://doi.org/10.1007/s11017-019-09509-5