Advertisement

Theoretical Medicine and Bioethics

, Volume 40, Issue 6, pp 487–506 | Cite as

Conscience, conscientious objections, and medicine

  • Rosamond RhodesEmail author
Article

Abstract

To inform the ongoing discussion of whether claims of conscientious objection allow medical professionals to refuse to perform tasks that would otherwise be their duty, this paper begins with a review of the philosophical literature that describes conscience as either a moral sense or the dictate of reason. Even though authors have starkly different views on what conscience is, advocates of both approaches agree that conscience should be obeyed and that keeping promises is a conscience-given moral imperative. The paper then considers exemplars of conscientious objection—Henry David Thoreau, Mohandas Gandhi, and Martin Luther King Jr.—to identify the critical feature of conscientious objection as willingness to bear the burdens of one’s convictions. It concludes by showing that medical professionals who put their own interests before their patients’ welfare violate their previous commitments and misappropriate the title “conscientious objector” because they are unwilling to bear the burdens of their choices and instead impose burdens on their patients and colleagues.

Keywords

Conscientious objection Conscience Medical professionals Patients Medicine Promise Henry David Thoreau Mahatma Gandhi Martin Luther King Jr. Duty 

Notes

References

  1. 1.
    Sharpsteen, Ben, Hamilton Luske, Bill Roberts, Norman Ferguson, Jack Kinney, Wilfred Jackson, and T. Hee (dirs.). 1940. Pinocchio. Burbank, CA: Walt Disney.Google Scholar
  2. 2.
    Mandeville, Bernard. 1969 [1725]. An enquiry into the origin of moral virtue. In British moralists 16501800, vol. 1, ed. D.D. Raphael, 229–236. London: Clarendon Press.Google Scholar
  3. 3.
    Rousseau, Jean-Jacques. 1979. Emile, or on education. Trans. Allan Bloom. New York: Basic Books.Google Scholar
  4. 4.
    Augustine. 1876. The confessions of St. Augustine, rev. ed. Trans. E.B. Pusey. Oxford: James Parker.Google Scholar
  5. 5.
    Bayle, Pierre. 2005 [1708]. A philosophical commentary on these words of the Gospel, Luke 14.23: Compel them to come in, that my House may be full, ed. John Kilcullen and Chandran Kukathas. Indianapolis: Liberty Fund.Google Scholar
  6. 6.
    Cragg, Gerald R. (ed.). 1968. The Cambridge Platonists. New York: Oxford University Press.Google Scholar
  7. 7.
    Joad, C.E.M. 1944. Guide to the philosophy of morals and politics. London: Victor Gollancz.Google Scholar
  8. 8.
    More, Henry. 1968 [1652]. An antidote against atheism. In The Cambridge Platonists, ed. Gerald R. Cragg, 163–193. New York: Oxford University Press.Google Scholar
  9. 9.
    Whichcote, Benjamin. 1968 [1753]. Moral and religious aphorisms. In The Cambridge Platonists, ed. Gerald. R. Cragg, 421–433. New York: Oxford University Press.Google Scholar
  10. 10.
    Shaftesbury, Anthony Ashley Cooper, Earl of. 1969 [1714]. An inquiry concerning virtue, or merit. In British moralists 16501800, vol. 1, ed. D.D. Raphael, 169–188. London: Clarendon Press.Google Scholar
  11. 11.
    Clarke, Samuel. 1969 [1728]. A discourse of natural religion. In British moralists 16501800, vol. 1, ed. D.D. Raphael, 191–225. London: Clarendon Press.Google Scholar
  12. 12.
    Butler, Joseph. 1969 [1749]. Fifteen sermons preached at the Rolls Chapel. In British moralists 16501800, vol. 1, ed. D.D. Raphael, 325–377. London: Clarendon Press.Google Scholar
  13. 13.
    Hutcheson, Francis. 1969 [1738]. Essays on the active powers of man. In British moralists 16501800, vol. 1, ed. D.D. Raphael, 261–299. London: Clarendon Press.Google Scholar
  14. 14.
    Reid, Thomas. 1969 [1788]. An inquiry concerning moral good and evil. In British moralists 16501800, vol. 2, ed. D.D. Raphael, 265–310. London: Clarendon Press.Google Scholar
  15. 15.
    Butler, Joseph. 1969 [1740]. Dissertation of the nature of virtue. In British moralists 16501800, vol. 1, ed. D.D. Raphael, 378–386. London: Clarendon Press.Google Scholar
  16. 16.
    McPherson, Thomas H. 1948. The development of Bishop Butler’s ethics. Philosophy 23: 317–331.CrossRefGoogle Scholar
  17. 17.
    Selby-Bigge, L.A. (ed.). 1923. British moralists. Indianapolis: Bobbs-Merrill.Google Scholar
  18. 18.
    Broad, C.D. 1930. Five types of ethical theory. London: Kegan Paul.Google Scholar
  19. 19.
    Baumrin, Bernard H. 1923. Introduction. In British moralists, ed. L.A. Selby-Bigge, xv–xvi. Indianapolis: Bobbs-Merrill.Google Scholar
  20. 20.
    Darwall, Stephen. 1995. The British moralists and the internal ‘ought’: 1640–1740. Cambridge: Cambridge University Press.CrossRefGoogle Scholar
  21. 21.
    Aquinas, Saint Thomas. 1947. Summa theologica. Trans. Fathers of the English Dominican Province. New York: Benziger.Google Scholar
  22. 22.
    Hobbes, Thomas. 1965. Hobbes’s leviathan. Oxford: Clarendon Press.Google Scholar
  23. 23.
    Kant, Immanuel. 1994 [1797]. The metaphysical principles of virtue. In Ethical philosophy, 2nd ed, trans. James W. Ellington, part 2. Indianapolis: Hackett.Google Scholar
  24. 24.
    Kant, Immanuel. 1994 [1785]. Grounding for the metaphysics of morals. In Ethical philosophy, 2nd ed, trans. James W. Ellington, part 1. Indianapolis: Hackett.Google Scholar
  25. 25.
    Lewis, C.S. 1967. Studies in words, 2nd ed. Cambridge: Cambridge University Press.Google Scholar
  26. 26.
    Kass, Leon. 1997. The wisdom of repugnance: Why we should ban the cloning of humans. New Republic 216(22): 17–26.Google Scholar
  27. 27.
    Midgley, Mary. 2000. Biotechnology and monstrosity: Why we should pay attention to the “yuk factor.” Hastings Center Report 30(5): 7–15.CrossRefGoogle Scholar
  28. 28.
    Schmidt, Charles W. 2008. The yuck factor: When disgust meets discovery. Environmental Health Perspectives 116(12): A524–A527.CrossRefGoogle Scholar
  29. 29.
    Thoreau, Henry David. 1849. Resistance to civil government. In Aesthetic papers, ed. Elizabeth P. Peabody, 189–211. Boston: John Wilson.Google Scholar
  30. 30.
    Gandhi, M.K. 1920. The congress and non-co-operation. Young India 2(31): 3.Google Scholar
  31. 31.
    King, Martin Luther. 1986. Remaining awake through a great revolution (31 March 1968). In A testament of hope: The essential writings and speeches of Martin Luther King, Jr., ed. James Melvin Washington, 268–278. San Francisco: HarperCollins.Google Scholar
  32. 32.
    Maddow, Rachel. 2018. Conscientious objectors to Trump border policy get free legal aid. The Rachel Maddow Show, aired June 21, 2018, on MSNBC. https://www.msnbc.com/rachel-maddow/watch/conscientious-objectors-to-trump-border-policy-get-free-legal-aid-1261516355689.
  33. 33.
    Office for Civil Rights. 2018. Conscience protections for health care providers. US Department of Health and Human Services. Last reviewed March 22, 2018. https://www.hhs.gov/conscience/conscience-protections/index.html.
  34. 34.
    Church Amendment, Health Programs Extension Act of 1973, Pub. L. No. 93-45, § 401, 87 Stat. 91, 95–96 (codified as amended at 42 U.S.C. § 300a-7).Google Scholar
  35. 35.
    Coats–Snowe Amendment, Omnibus Consolidated Rescissions and Appropriations Act of 1996, Pub. L. No. 104-134, § 515, 110 Stat. 1321, 1321-245 (codified at 42 U.S.C. § 238n).Google Scholar
  36. 36.
    Weldon Amendment, Consolidated Appropriations Act of 2004, Pub. L. No. 108-199, § 634, 118 Stat. 3, 101.Google Scholar
  37. 37.
    Patient Protection and Affordable Care Act of 2010, Pub. L. No. 111-148, § 1303(b)(4), 124 Stat. 119, 899 (codified at 42 U.S.C. § 18023).Google Scholar
  38. 38.
    Rhodes, Rosamond. 2019. Why not common morality? Feature article. Journal of Medical Ethics.  https://doi.org/10.1136/medethics-2019-105621.CrossRefGoogle Scholar
  39. 39.
    Brennan, Troy, Linda Blank, and ABIM Foundation, ACP–ASIM Foundation, and European Federation of Internal Medicine. 2002. Medical professionalism in the new millennium: A physicians’ charter. Lancet 359: 520–522.CrossRefGoogle Scholar
  40. 40.
    Brennan, Troy, Linda Blank, and ABIM Foundation, ACP–ASIM Foundation, and European Federation of Internal Medicine. 2002. Medical professionalism in the new millennium: A physician charter. Annals of Internal Medicine 136: 243–246.CrossRefGoogle Scholar
  41. 41.
    Cruess, Richard L., and Sylvia R. Cruess. 2008. Expectations and obligations: Professionalism and medicine’s social contract with society. Perspectives in Biology and Medicine 51: 579–598.CrossRefGoogle Scholar
  42. 42.
    Miles, Steven H. 2004. The Hippocratic Oath and the ethics of medicine. New York: Oxford University Press.Google Scholar
  43. 43.
    Association of American Medical Colleges and the American Medical Association. 2014. Liaison Committee on Medical Education, Functions and Structure of a Medical School Standards for Accreditation of Medical Education Programs Leading to the M.D. Degree.Google Scholar
  44. 44.
    Brody, Howard, and David Doukas. 2014. Professionalism: A framework to guide medical education. Medical Education 48: 980–987.CrossRefGoogle Scholar
  45. 45.
    Carrese, Joseph A., Janet Malek, Katie Watson, Lisa Soleymani Lehmann, Michael J. Green, Laurence B. McCullough, Gail Geller, Clarence H. Braddock III, and David J. Doukas. 2015. The essential role of medical ethics education in achieving professionalism: The Romanell report. Academic Medicine 90: 744–752.CrossRefGoogle Scholar
  46. 46.
    DeAngelis, Catherine D. 2014. Medical professionalism in the twenty-first century. In Patient care and professionalism, ed. Catherine D. DeAngelis, 61–76. New York: Oxford University Press.Google Scholar
  47. 47.
    Byyny, Richard L. 2017. Reflections on best practices for medical professionalism in the modern era. In Medical professionalism best practices: Professionalism in the modern era, ed. Richard L. Byyny, Douglas S. Paauw, Maxine Papadakis, and Sheryl Pfeil, 129–143. Aurora: Alpha Omega Alpha Honor Medical Society.Google Scholar
  48. 48.
    Humphrey, Holly, and Dana Levinson. 2017. Becoming a doctor: The learner and the learning environment—a complex interaction. In Medical professionalism best practices: Professionalism in the modern era, ed. Richard L. Byyny, Douglas S. Paauw, Maxine Papadakis, and Sheryl Pfeil, 97–116. Aurora: Alpha Omega Alpha Honor Medical Society.Google Scholar
  49. 49.
    Locke, John. 2010. A letter concerning toleration. In A letter concerning toleration and other writings, ed. Mark Goldie, 1–67. Indianapolis: Liberty Fund.Google Scholar
  50. 50.
    Pellegrino, Edmund D. 2002. Professionalism, profession and the virtues of the good physician. Mount Sinai Journal of Medicine 69: 378–384.Google Scholar
  51. 51.
    Pellegrino, Edmund D. 1987. Altruism, self-interest, and medical ethics. Journal of the American Medical Association 258: 1939–1940.CrossRefGoogle Scholar
  52. 52.
    Pellegrino, Edmund D. 1987. Toward a reconstruction of medical morality. Journal of Medical Humanities and Bioethics 8: 7–18.CrossRefGoogle Scholar
  53. 53.
    Sulmasy, Daniel P. 2017. Tolerance, professional judgment, and the discretionary space of the physician. Cambridge Quarterly of Healthcare Ethics 28: 18–31.CrossRefGoogle Scholar
  54. 54.
    Locke, John. 2010. An essay concerning toleration. In A letter concerning toleration and other writings, ed. Mark Goldie, 105–140. Indianapolis: Liberty Fund.Google Scholar
  55. 55.
    Sulmasy, Daniel P. 2019. Conscience, tolerance, and pluralism in health care. Theoretical Medicine and Bioethics.  https://doi.org/10.1007/s11017-019-09509-5.CrossRefGoogle Scholar
  56. 56.
    Nelson, Lawrence. 2018. Provider conscientious refusal of abortion, obstetrical emergencies, and criminal homicide law. American Journal of Bioethics 18(7): 43–50.CrossRefGoogle Scholar
  57. 57.
    Kaye, Julia, Brigitte Amiri, Louise Melling, and Jennifer Dalven. 2016. Health care denied: Patients and physicians speak out about Catholic hospitals and the threat to women’s health and lives. New York: American Civil Liberties Union.Google Scholar

Copyright information

© Springer Nature B.V. 2019

Authors and Affiliations

  1. 1.Icahn School of Medicine at Mount SinaiNew YorkUSA

Personalised recommendations