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Negative and Positive Claims of Conscience

Published online by Cambridge University Press:  01 January 2009

MARK R. WICCLAIR
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Extract

Discussions of appeals to conscience by healthcare professionals typically focus on situations in which they object to providing a legal and professionally permitted service, such as abortion, sterilization, prescribing or dispensing emergency contraception, and organ retrieval pursuant to donation after cardiac death. “Negative claims of conscience” will designate such appeals to conscience. When healthcare professionals advance a negative claim of conscience, they do so to secure an exemption from ethical, professional, institutional, and/or legal obligations or requirements to provide a healthcare service.

Type
Special Section: Open Forum
Information
Cambridge Quarterly of Healthcare Ethics , Volume 18 , Issue 1 , January 2009 , pp. 14 - 22
Copyright
Copyright © Cambridge University Press 2009

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References

1. 42 USCS § 300a-7 (1973).

2. Wardle LD. Protecting the rights of conscience of health care providers. The Journal of Legal Medicine 1993;14:177–230.

3. Division F, Title B, Section 508d, 1-2 of the Consolidated Appropriations Act of 2005 (Pub. L. No. 108-447, 118 Stat. 2809).

4. 20 PA. CONS. STAT. ANN. § 54.

5. South Dakota HB 1215 added sections 17-7 through 17-12 to S.D. Codified Laws § 22-17 and repealed sections 23-A-2 to 23-A-5 of S.D. Codified Laws § 34-23. These changes were rejected by a November 7, 2006, referendum. HB 1215 defined “unborn human being" as “an individual living member of the species, homo sapiens, throughout the entire embryonic and fetal ages of the unborn child from fertilization to full gestation and childbirth.”

6. The proposed bill is available at: http://www.govtrack.us/congress/billtext.xpd?bill=h109-4437; accessed May 28, 2008.

7. Cohen SA. Global gag rule: Exporting antiabortion ideology at the expense of American values. Guttmacher Report on Public Policy 2001:1–3. Available at: http://www.guttmacher.org/pubs/tgr/04/3/gr040301.pdf; accessed May 28, 2008.

8. Wicclair MR. Conscientious objection in medicine. Bioethics 2000;14(3):205–27.

9. Singer MG. Negative and positive duties. The Philosophical Quarterly 1965;15(59):98–9.

10. Narveson J. Positive/negative: Why bother? Tulane Studies in Philosophy 1985;XXXIII:51.

11. Malm HM. Between the horns of the negative–positive duty debate. Philosophical Studies 1991;61:187.

12. Belliotti RA. Negative and positive duties. Theoria 1981;47:82.

13. Davis N. The priority of avoiding harm. In: Steinbock B, ed. Killing and Letting Die. Englewood Cliffs, NJ: Prentice-Hall, Inc.; 1980:179.

14. Malm exemplifies this approach. See note 11, Malm 1991.

15. See, for example, Abelson R. To do or let happen. American Philosophical Quarterly 1982;19(3):219–28.

16. See, for example, Gorr M. Some reflections on the difference between positive and negative duties. Tulane Studies in Philosophy 1985;XXXIII:93–100; Green OH. Killing and letting die. American Philosophical Quarterly 1980;17:195–204.

17. See, for example, Wreen M. Breathing a little life into a distinction. Philosophical Studies 1984;46:395–402.

18. See, for example, Trammell RL. Saving life and taking life. The Journal of Philosophy 1975;72(5):131–7.

19. See, for example, Fitzgerald PJ. Acting and refraining. Analysis 1967;27(4):133–9; Trammell RL. A criterion for determining negativity and positivity. Tulane Studies in Philosophy 1985;XXXIII:75–81.

20. Trammel exemplifies this approach. See note 18, Trammel 1975.

21. Narveson offers a contractarian account. See note 10, Narveson 1985.

22. For the purpose of considering whether the selective protection of negative claims of conscience is justified, it is not necessary to specify criteria for identifying N-duties that correspond to P-duties. Moreover, nothing relevant to this issue turns on whether the N-duties and P-duties that are cited as examples of corresponding duties satisfy the appropriate criteria.

23. That conclusion requires the additional assumption that a violation of a duty for which an agent is more culpable or blameworthy provides a basis for an appeal to conscience with more moral weight.