A) With respect to morally
contested procedures and services, a so-called 'consensus' that they
are "ethical" is typically achieved by excluding from consideration opinions
that are at odds with the ethical, moral or religious presuppositions shared
by a dominant elite. The resulting 'consensus' is, in reality, simply the
majority opinion of like-minded individuals, achieved by excluding those who
think differently. It is not a genuine ethical synthesis reflecting
A) To identify beliefs as
'private' or 'personal' does not help to resolve a question about the
exercise of freedom of conscience. The beliefs of many conscientious
objectors, while certainly personal in one sense, are actually shared with
tens of thousands, or even hundreds of thousands or hundreds of millions of
people, living and dead, who form part of great religious, philosophical and
moral traditions. If their beliefs are 'private,' those of the members of a
particular professional group are not less so. Disputes about what counts as
'private' or 'public' thus end in a stalemate. Further: the "ethics of
the profession" have too often supported conduct now considered to be
unethical, such as the operation of eugenics boards in North America until
late in the twentieth century.
Society has given medical professionals a monopoly on the delivery
of health care. In return for the power, prestige and wealth that
this monopoly provides, they ought to provide the services sought by
A) Social contract theory
is a tool developed to explore different aspects of human relationships.
It remains a theory that fails to address the actual historical development
of the practice of medicine, and is itself contested for other reasons.
Moreover, even if there could be said to be some kind of 'contract,' the
content of the contract is disputed.
A) "Society" does not expect
them to provide the services and procedures because "society" includes
people who share the beliefs of objecting health care workers. They
have invested in the education of medical professionals no less than those
who disagree with them. Only by denying that these people are a part
of society is it possible to maintain the fiction that "society" expects
objectors to do what they believe to be wrong.
A) Some health care workers
who refuse to provide procedures for reasons of consience are willing to
refer patients to others who will. However, other health care workers
will not refer patients because they believe that referral or other forms of
facilitation make them morally responsible for the act that follows.
A) In the same way that
someone who provides a gun and a getaway car for a bank robbery shares in
the moral responsibility for the robbery and all of the harms that come from
it, even if someone else actually commits the robbery.
A) The concern is not legal,
but moral and ethical. Capital punishment is legal in a number of
jurisdictions, but most professional medical associations insist that their
members must not participate in executions, even when the law requires the
involvement of a medical practitioner. And by "participation" they
mean both direct and indirect involvement. (See, for example,
American Medical Association
Policy E-2.06: Capital Punishment.) This is exactly the same
kind of moral reasoning applied by conscientious objectors who refuse to
facilitate procedures by referral or other means.
A) No. This amounts to a
claim that a health care worker can be compelled to do what some other
person believes is a lesser wrong, or what some other person thinks is not
"really" a wrong at all. In short, it means that health care workers
can be compelled to practise according to the conscientious convictions of
someone else, to serve ends chosen by someone else even if he finds them
abhorrent. This is a form of servitude, not service. It does not
merely limit freedom of conscience. It suppresses
A) There are limits to freedom
of concience. However, the limits may be determined by reference to
the nature of the human person, human freedom and moral responsibility, not
by reference to laws of supply and demand, convenience or delivery of public