Can Institutions Exercise Conscientious Objection?
Thursday, October 12, 2023
2:30 PM – 3:45 PM ET
Location: Galena (Fourth Floor)
While the motivating values behind exercises of conscience often are religious, there is wide consensus that the secular moral convictions of clinicians should be equally protected. Religious institutions have enjoyed conscience protections for wholesale refusal of interventions that conflict with their institutional values. But the justification for these sorts of institutional protections appears to rely on an unexamined analogy between individual and institutional conscience. In this paper, we unpack the ethical justifications for the exercise of conscience at the individual level and propose an analogous set of criteria for institutional conscience. The implications of this are significant: If institutions can exercise conscience-based refusals, and religious affiliation is not a condition for the ethical exercise of conscience, then secular institutions also should be able to exercise conscience-based refusals as well. In turn, secular hospitals could ground refusal to offer interventions they believe are medically inappropriate such as tracheostomy and PEG tube placement for likely permanently unconscious patients in their own institutional values. Recognition of institutional conscience provides a more stable basis for such refusals, which otherwise are subject to more contestable claims involving futility or best interest. Recognition of secular institutional conscience protections would therefore mitigate clinician liability and the stress of the ever-present specter of legal consequence. In turn, it would mitigate the moral injury and burnout experienced by so many physicians and nurses who currently feel compelled to provide care that they deeply believe is morally wrong, yet does not meet criteria for futility or inappropriate care.
Abram Brummett – Foundational Medical Studies – OUWB