Conscientious objection in healthcare: new directions

International Journal of Gynecology & Obstetrics, 2009

NOTRE DAME JOURNAL OF INTERNATIONAL AND COMPARATIVE LAW, 2013

Bioethics, 2018

Daniel Sulmasy has recently argued that good medicine depends on physicians having a wide discretionary space in which they can act on their consciences. The only constraints Sulmasy believes we should place on physicians' discretionary space are those defined by a form of tolerance he derives from Locke whereby people can publicly act in accordance with their personal religious and moral beliefs as long as their actions are not destructive to society. Sulmasy also claims that those who would reject physicians' right to conscientious objection eliminate discretionary space thus undermining good medicine and unnecessarily limiting religious freedom. I argue that, although Sulmasy is correct that some discretionary space is necessary for good medicine, he is wrong in thinking that proscribing conscientious objection entails eliminating discretionary space. I illustrate this using Julian Savulescu and Udo Schuklenk's system for restricting conscientious objections as a counterexample. I then argue that a narrow discretionary space constrained by professional ideals will promote good medicine better than Sulmasy's wider discretionary space constrained by his conception of tolerance. Sulmasy's version of discretionary space would have us tolerate actions that are at odds with aspects of good medicine, including aspects that Sulmasy himself explicitly values, such as fiduciary duty. Therefore, if we want the degree of religious freedom in the public sphere that Sulmasy favours then we must decide whether it is worth the cost to the healthcare system.

Bioethics, 2015

West-Oram, Peter, and Alena Buyx. "Conscientious objection in healthcare provision: A new dimension." Bioethics 30.5 (2016): 336-343., which has been published in final form at [10.1111/bioe.12236]. This article may be used for noncommercial purposes in accordance with Wiley Terms and Conditions for Self-Archiving. 4 R. S. Dr es se r. ' Fr e ed o m o f Co ns ci e nce, P ro fe s si o na l Re sp o n sib il it y, a nd Acce s s to Ab o r tio n '. J L a w Med Eth ic s 1 9 9 4 ; 2 2 : 2 8 0-285: 2 8 0. 5 E.D. P e lle gr i no. 'T h e P h ys ic ia n 's Co n sci e nce , Co n sc ie nce C la u se s, a n d Re li g io us B el ie f : A Ca t ho l ic P er sp e ct i ve '. Fo r d h a m U rb a n La w J 2 0 0 2 ; 3 0 : 2 2 1-2 4 4 : 2 2 6 , 2 3 9 .

The main aim of the ACA is to reduce the number of uninsured Americans and the overall costs of health care in America. This symposium discusses one type of argument that critics have levelled against the ACA. Arguments of this type loomed large in discussions of the legal challenge to the ACA. According to them, the ACA does not accommodate rights of conscientious objection to the ACA mandate to fund contraceptive and, as some of the allege, abortive services. For example, as the Supreme Court was deliberating, Timothy Dolan, the archbishop of New York and president of the US Conference of Catholic Bishops, wrote in the Wall Street Journal, Coercing religious ministries and citizens to pay directly for actions that violate their teaching is an unprecedented incursion into freedom of conscience […] Quakers and others object to killing even in wartime, and the government respects that principle for conscientious objectors. By its decision, the Obama administration has failed to show the same respect for the consciences of Catholics and others who object to treating pregnancy as a disease (Dolan 2012).

In the paradigmatic case of conscientious objection, the objector claims that his religion forbids him from actively participating in a wrong (for example, by fighting in a war). In the religious challenges to the Affordable Care Act's employer mandate, on the other hand, employers claim that their religious convictions forbid them from merely subsidizing insurance through which their employees might commit a wrong (for example, by using contraception). The understanding of complicity underpinning these challenges is vastly more expansive than the standard that legal doctrine or moral theory contemplates. Courts routinely reject claims of conscientious objection to taxes that fund military initiatives or to university fees that support abortion services. In Hobby Lobby, however, the Supreme Court took the corporate owners at their word: the mere fact that Hobby Lobby believed that it would be complicit, no matter how idiosyncratic its belief, sufficed to qualify it for an exemption. In this way, the Court made elements of an employee's health-care package the " boss's business " (to borrow from the nickname of the Democrats' proposed bill to overturn Hobby Lobby). Much of the critical reaction to Hobby Lobby focuses on the issue of corporate rights of religious freedom. Yet this issue is a red herring. The deeper concerns that Hobby Lobby raises—about whether employers may now refuse, on religious grounds, to subsidize other forms of health coverage (for example, blood transfusions or vaccinations) or to serve customers whose lifestyles they deplore (for example , gays and lesbians)—do not turn on the organizational form that the employer † Assistant Professor, Department of Legal Studies and Business Ethics, The

Ethical and Legal Debates In Irish Healthcare, 2016

In addition to providing legal precedent, court cases may serve as stories for explaining and exploring how conscientious objection impacts the lives of patients, their families and clinicians. The list of cases that follows is not meant to be exhaustive bibliography of case law, but (rather) reflects those cases which have been discussed in secondary literature. Sebelius v. Hobby Lobby Stores, Inc. 134 S. Ct. 678 (2013). 1 Opinion of the court: pending. Argued before the U.S. Supreme Court on March 25, 2014, 2 this case addresses the issue of whether or not the Affordable Care Act 3 compels for-profit corporations to provide health coverage for contraception and other care that the corporation owners might consider objectionable. Also see: Hobby Lobby Stores, Inc. v. Sebelius, 723 F. 3d. 1114 (10 th Cir. 2013). 4 Discussed in Lynch; Mattingly; Meese & Oman; Nelson; Rienzi; Scharffs; Smith; Totenberg; Vanderbilt Law Review; Whelan. 5-14 Stormans, Inc. v. Selecky, 586 F.3d 1109 (9th Cir. 2009). Opinion of the Court: The state may not force pharmacies to dispense Plan B (and all FDA-approved drugs) as this is contrary to the First Amendment. Discussed in: Lynch; Mau.

Ethical Perspectives, 20(1): 109-117