Commentary: Special Issue on Conscientious Objection.

This special issue of HEC Forum includes articles on a wide range of specific topics that make significant contributions to conscientious objection scholarship. In this commentary, it is not feasible to provide a comprehensive analysis of each of the articles; and I have not attempted to do so. Instead, for each article, I have selected specific issues and arguments on which to comment.

Preventing conscientious objection in medicine from running amok: a defense of reasonable accommodation.

A US Department of Health and Human Services Final Rule, Protecting Statutory Conscience Rights in Health Care (2019), and a proposed bill in the British House of Lords, the Conscientious Objection (Medical Activities) Bill (2017), may well warrant a concern that-to borrow a phrase Daniel Callahan applied to self-determination-conscientious objection in health care has "run amok." Insofar as there are no significant constraints or limitations on accommodation, both rules endorse an approach that is aptly designated "conscience absolutism." There are two common strategies to counter conscience absolutism and prevent conscientious objection in medicine from running amok.

Conscientious Objection, Moral Integrity, and Professional Obligations.

Lauris Kaldjian defends conscientious objection against opponents who claim that there is no place for a physician's personal moral beliefs in the practice of medicine. This essay argues that Kaldjian's defense of conscientious objection relies on a controversial "thick" conception of conscience that opponents may justifiably question. It offers a defense that relies on a relatively "thin" conception of conscience as an agent's core moral beliefs and that understands conscience-based refusals to provide medical services as refusals based on those core beliefs.

Justifying Conscience Clauses.

In "Disentangling Conscience Protections," in this issue of the Hastings Center Report, Nadia Sawicki offers a taxonomy of conscience protection laws (conscience clauses) that highlights the expansive protections they can offer to health professionals who refuse to provide a medical service for reasons of conscience. Conscience clauses can protect health professionals from adverse actions by public actors (such as administrative agencies, prosecutors, and government funders) or private actors (such as employers, private professional associations, and injured patients), and they can also protect health professionals from being subject to adverse actions for their beliefs, their conduct, or harm that results from their conduct. This taxonomy provides an accurate description of the broad range of protections conscience clauses can offer and thereby is a valuable contribution to the scholarly literature on conscientious objection in health care.

Robots as Imagined in the Television Series Humans.

Humans is a science fiction television series set in what appears to be present-day London. What makes it science fiction is that in London and worldwide, there are robots that look like humans and can mimic human behavior. The series raises several important ethical and philosophical questions about artificial intelligence and robotics, which should be of interest to bioethicists.

Conscientious Objection in Healthcare and Moral Integrity.

There are several reasons for accommodating health professionals' conscientious objections. However, several authors have argued that among the most important and compelling reasons is to enable health professionals to maintain their moral integrity. Accommodation is said to provide "moral space" in which health professionals can practice without compromising their moral integrity.

An official American Thoracic Society policy statement: managing conscientious objections in intensive care medicine.

Rationale: Intensive care unit (ICU) clinicians sometimes have a conscientious objection (CO) to providing or disclosing information about a legal, professionally accepted, and otherwise available medical service. There is little guidance about how to manage COs in ICUs.

Objectives: To provide clinicians, hospital administrators, and policymakers with recommendations for managing COs in the critical care setting.

Surgeons, intensivists, and discretion to refuse requested treatments.

Physicians are expected to engage patients as partners in identifying the possible benefits and harms associated with treatment options and selecting from among medically appropriate treatment options, rather than simply dictating what treatments patients will and will not receive. This collaborative model reflects the recognition that citizens in multicultural societies have diverse values and are likely to have different views about whether the possible benefits of a medical intervention outweigh the possible harms. However, there are circumstances in which the collaborative process breaks down due to irresolvable disagreement.

Managing conscientious objection in health care institutions.

It is argued that the primary aim of institutional management is to protect the moral integrity of health professionals without significantly compromising other important values and interests. Institutional policies are recommended as a means to promote fair, consistent, and transparent management of conscience-based refusals. It is further recommended that those policies include the following four requirements: (1) Conscience-based refusals will be accommodated only if a requested accommodation will not impede a patient's/surrogate's timely access to information, counseling, and referral.