Brock, Conscientious Refusal by Physicians and Pharmacists (1)

Abstract

  • Some medical services generate deep moral controversy leading to conscientious refusals by physicians.

  • Pharmacists also refuse to fill legal prescriptions based on conscience.

  • The paper outlines:

    • The basis and limits of freedom to act on one's conscience.

    • Responsibilities of medical and pharmacy professions.

    • The "conventional compromise" as an accommodation for conflicts between professional responsibilities and personal moral integrity.

    • Rejection of the complicity objection to the conventional compromise.

Introduction

  • Medical services like abortion have led to conscientious refusals by some physicians.

  • Other examples include:

    • Growth hormone use.

    • Assisted reproductive services for unmarried couples.

    • HPV vaccine for young girls.

    • Terminal sedation for dying patients.

    • Physician-assisted suicide.

  • Pharmacists have refused to fill prescriptions due to moral objections.

  • Claim of moral (and legal) right to refuse is termed conscientious refusal.

Right of Conscience

  • Conscience defined as an individual's capacity for moral judgment and commitment to act on those judgments.

  • Moral judgments from conscience can be informed by religious beliefs, but not necessarily.

  • Discussions of epistemic status of these judgments emphasize they cannot be categorized as true or justified universally.

  • Justification of moral judgments is complex; it's not feasible to impose one morally justified view on another.

Moral Integrity and Its Limits

  • Maintaining moral integrity is crucial; it defines an individual's character and moral core.

  • Respecting others' moral integrity can conflict with other social values.

  • Two illustrative cases:

    1. Dr. A refuses to treat black patients based on racial beliefs, which is publicly considered unethical.

    2. Dr. B, believing blood transfusions threaten salvation, refuses to transfuse patients.

Responses to Conscientious Refusal

  • Dr. A:

    • Not justified to discriminate racially, despite personal beliefs.

    • Public policy ensures equal access to healthcare services.

  • Dr. B:

    • Although her beliefs are respected, her professional duty to save lives must take precedence.

    • Emergency medical roles necessitate certain responsibilities that cannot be avoided without ethical conflict.

Profession's Responsibilities

  • Each profession must ensure competent service to the public and comply with legal norms (anti-discrimination).

  • Responsibilities arise from:

    • Voluntary acceptance by professional societies (codes of ethics).

    • State governance, providing licenses in exchange for public protection.

  • Development of responsibilities involves multiple stakeholders:

    • Regulatory bodies, courts, and the public.

Conventional Compromise

  • A physician or pharmacist can refuse a service if three conditions are met:

    1. Inform the patient about the service if relevant to their medical condition.

    2. Refer to another willing professional.

    3. Ensure the referral does not impose unreasonable burdens on the patient.

  • Conditions ensure that individual moral integrity is maintained while fulfilling professional obligations.

Conditions of the Conventional Compromise

  • Condition 1: Clarification needed for what is deemed relevant.

  • Condition 2: Professionals must know alternative providers beforehand.

  • Condition 3: Unreasonable burden is context-dependent (distance, urgency).

  • Failure to adhere to these conditions risks professional negligence.

Acceptance of the Conventional Compromise

  • Survey findings show significant percentages of physicians do not believe it's necessary to present all options to patients or refer them, which is concerning.

  • Regulatory authorities should impose conditions to ensure professional obligations are satisfied despite personal moral objections.

Complicity Objection to the Conventional Compromise

  • Informing and referring may result in a degree of complicity, which needs addressal but should not negate the conventional compromise.

  • Professional roles carry obligations exceeding personal beliefs; they must prioritize patient welfare over moral integrity when conflicts arise.

Conclusion

  • Reviewed the basis of conscience.

  • Explored profession’s responsibilities and the need for evolution in response to societal changes.

  • Defended the conventional compromise while examining objections to its implementation.