The Practitioner’s Paradox: Conscientious but …Without Conscience

Article Sidebar

PDF Download PDF Download
Published Jan 31, 2023

Downloads

Download data is not yet available.

Submit your own article

Register as an author to reserve your spot in the next issue of the Medical Research Archives.

Author Registration

Join the Society

The European Society of Medicine is more than a professional association. We are a community. Our members work in countries across the globe, yet are united by a common goal: to promote health and health equity, around the world.

Join Europe’s leading medical society and discover the many advantages of membership, including free article publication.

Membership

Main Article Content

Tom Koch
University of British Columbia, Vancouver, BC, Canada

Abstract

Over the last decade a group of moral philosophers concerned with medicine have argued, some stridently, that conscience has no place in the conscientious practice of medicine. And yet, it is hard to separate conscience from conscientiousness. This paper reviews and critiques the argument against conscience and the assumptions underlying it. It argues that it is often difficult to separate conscience, a moral perspective on appropriate practice, from the clinical knowledge and experience that practitioners possess and patients do not. The result is not paternalistic although it challenges the assumption that the patient in distress often knows best. The focus in this paper shifts from simple autonomy as a reflexive rule to the social and broadly clinical context in which decisions about procedures like abortion and medically assisted death are made.

Keywords: ethics, conscience, medicine, moral philosophy, practitioner

Article Details

How to Cite
KOCH, Tom. The Practitioner’s Paradox: Conscientious but …Without Conscience. Medical Research Archives, [S.l.], v. 11, n. 1, jan. 2023. ISSN 2375-1924. Available at: <https://esmed.org/MRA/mra/article/view/3558>. Date accessed: 21 nov. 2024.
ABNT APA BibTeX CBE EndNote - EndNote format (Macintosh & Windows) MLA ProCite - RIS format (Macintosh & Windows) RefWorks Reference Manager - RIS format (Windows only) Turabian
Issue
Vol 11 No 1 (2023): January Issue, Vol.11 Issue 1
Section
Research Articles

The Medical Research Archives grants authors the right to publish and reproduce the unrevised contribution in whole or in part at any time and in any form for any scholarly non-commercial purpose with the condition that all publications of the contribution include a full citation to the journal as published by the Medical Research Archives.

 

References

1. AMA Code of Medical Ethics (2016). Chicago: American Medical Association. https://www.ama.-assn.org./about-us/code-medical-ethics.
2. Azar A. II. Coats Amendment. (1996, March 19). Protecting Statutory Conscience Rights in Health Care; Delegations of Authority. Office for Civil Rights; Office of the Secretary: 45 CFR Part 88 RIN 0945‐AA10. https://www.hhs.gov/sites/default/files/final-conscience-rule.pdf.
3. Balanced Budget Down Payment Act. Amendment No. 3508. Congressional Record 142 (38). https://www.govinfo.gov/content/pkg/CREC-1996-03-19/html/CREC-1996-03-19-pt1-PgS2268.htm.
4. Brody H, Miller FG. (1998). The internal morality of medicine: Explication and application to managed care. Journal of Medicine and Philosophy 23 (4): 384–410. Doi: 10.1076/jmep.23.4.384.2572.
5. Carter v Canada. (2015). 1 SCR 331.
6. Conscience. Merriam Webster Dictionary Online. https://www.merriam-webster.com/dictionary/conscience. Accessed July 31, 2011.
7. Conscientious. Encyclopedia.Com, Oxford University Press. https://www.encyclopedia.com/literature-and-arts/language-linguistics-and-literary-terms/english-vocabulary-d/conscientious. Accessed July 31, 2022.
8. Conscientious. Merriam Webster Dictionary Online. https://www.merriam-webster.com/dictionary/conscientious.
9. Liu I. (2022). Personal Interview. Vancouver, BC. Aug. 26.
10. Koch T. (2000). Life quality versus the ‘quality of life’” assumptions underlying prospective quality of life instruments in health care planning. Social Science & Medicine 51:3, 419-428.
11. Koch T. (2001). Future States: Testing the axioms underlying prospective, future-oriented, health planning instruments. Social Science & Medicine 52:3, 453-466 https://doi.org/10.1016/S0277-9536(00)00154-4.
12. Koch T. (2006). Weaponising Medicine: "Tutti fratelli," no more J. Med. Ethics 32: 252-255. Doi:10.1136/jme.2006.016485.
13. O’Neill O. (2004). Autonomy, plurality and public reason. In, New Essays on the history of autonomy: A Collection Honoring J.B. Schneewind. Eds. N. Brender and L. Krashnoff. Cambridge: Cambridge University Press, 181-194.
14. R. v Morgentaler, [1988]. 1 SCR 30.
15. Savulescu J. (2006). Conscientious objection in medicine. British Medical Journal 332 294–297. Doi: 10.1136/bmj.332.7536.294.
16. Schücklenk U., Smalling R. (2017). Why medical professionals have no moral claim to conscientious objection accommodation in liberal democracies. Journal of Medical Ethics 43, (4): 234-240. URL: https://www.jstor.org/stable/44606262
17. Schneewind J. B. (1998). The Invention of Autonomy: A History of Modern Philosophy. Cambridge, Cambridge University Press.
18. Savulesqu J. (2006). Conscientious objection in medicine. BMJ (4 Feb.): 332 (294): 294-297. Doi: https://doi.org/10.1136/bmj.332.7536.294
19. Weldon Amendment, Consolidated Appropriations Act, 2009, Pub. L. No. 111-117, 123 Stat 3034. https://www.hhs.gov/sites/default/files/ocr/civilrights/understanding/ConscienceProtect/publaw111_117_123_stat_3034.pdf.
20. Fikremariam D, Serafini M. Multidisciplinary approach to pain management. In: Vadivelu N, Urman RD, Hines RL, eds. Essentials of Pain Management. Springer; 2011:17-28. doi:10.1007/978-0-387-87579-8