Civil Disobedience, Not Merely Conscientious Objection, In Medicine
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Civil Disobedience, Not Merely Conscientious Objection, In Medicine Dana Howard1
© Springer Nature B.V. 2020
Abstract Those arguing that conscientious objection in medicine should be declared unethical by professional societies face the following challenge: conscientious objection can function as an important reforming mechanism when it involves health care workers refusing to participate in certain medical interventions deemed standard of care and legally sanctioned but which undermine patients’ rights. In such cases, the argument goes, far from being unethical, conscientious objection may actually be a professional duty. I examine this sort of challenge and ultimately argue that these acts of conscience done in the interest of reforming professional norms or medical regulations are best understood as episodes of civil disobedience rather than episodes of conscientious objection. In contrast to the private, exempting nature of conscientious objection, civil disobedience is a public breach of a norm or law undertaken with the aim of bringing about a change in governmental policies or professional standards. Consequently, clinicians may have a duty to engage in civil disobedience even while professional societies are right to declare limitations on the ethical appropriateness of conscientious objection.
Introduction Recently, a number of prominent bioethicists have taken a critical stance against conscientious objection in medicine and some have advocated for professional organizations to remove or defang the conscience clauses in their codes of ethics (Charo 2005; Savulescu; 2006; Stahl and Emanuel 2017; Schuklenk and Smalling 2017). They argue that when one’s conscience and one’s professional duties conflict, the professional duties should be prioritized in order to ensure equitable access to healthcare and respect for patients’ rights. Defenders of such clauses tend to respond to the criticisms without denying the critics’ main premise that * Dana Howard [email protected] 1
Division of Bioethics, Department of Biomedical Anatomy and Education, Ohio State University College of Medicine, Graves Hall 2018, Columbus, USA
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the impetus for conscientious objection grows out of the possible conflict between one’s professional duties and one’s personal convictions. Instead, defenders argue that sometimes, medical practitioners should be afforded some leeway to act on their conscience even if doing so may be unprofessional and that professional societies should publicly identify this affordance as a right of its individual members. Call this the “Accommodation Defense” [AD] of conscientious objection. This paper explores another possible defense for acting on one’s conscience in the realm of medicine: in certain circumstances, acting on one’s conscience in opposition to the current professional standards or regulations can be an influential mode of protest and may be employed as a tool to transform the standing professional norms for the better. On this defense, far from being
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