A newly released edition of the journal Perspectives in Medicine and Biology focuses on the theme of conscience in healthcare, and seeks to provide a deeper analysis of how conscience relates to good medical practice. The themed issue of Perspectives comes in the wake of two other themed editions of major bioethics journals that criticised conscientious objection in medicine.
The editors of the special issue, Dr Farr Curlin (Duke University) and Dr Kevin Powell (a pediatrician based in St Louis), argue that debate on conscientious objection has failed to address deeper questions about the nature of medical practice and the role of conscience in professional life:
“The dialogue [on conscientious objection] has often been hindered by participants talking past one another, using contested terms in different ways without argument, and leaving unspoken the participants' premises regarding what medicine is for and how practicing conscientiously relates to good medicine”.
The essays in the issue seek to tackle some of these basic topics. The collection begins with a paper by Lauris Kaldjian (University of Iowa), which argues that the exercise of conscience is inseparable from ethics and from the practice of medicine. Kaldjian proposes that the public should grant physicians substantial latitude to refuse to participate in practices that the physician, in his or her “final and best assessment”, believes fall “outside the scope of healing”.
Abraham Nussbaum (University of Colorado Denver) challenges the language that portrays physicians as either loyal soldiers or conscientious objectors, and he explores two 20th-century examples in which dissent within psychiatry led to needed reform of the profession.
Farr Curlin and Christopher Tollefsen (University of South Carolina) argue that the conscientious refusals that have drawn attention are in fact refusals based on medical reasons—based on judgments about what good medicine requires and permits. They call for such refusals to be accommodated, even celebrated, and for physicians to refuse to cooperate in any intervention that contradicts the physician's commitment to the patient's health, no matter how legal and professionally permitted that intervention is.
While several themes are explored in the special issue of Perspectives, its greatest contribution lies in its robust exploration of the Hippocratic idea of a doctor as a healer, and a consideration of what this means for conscientious objection in medicine.
Xavier Symons is Deputy Editor of BioEdge
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