比特派安卓中文版app|ethics of accommodation

作者: 比特派安卓中文版app
2024-03-14 20:53:32

‘Actual Lives’ and the Ethic of Accommodation | 33 | The Community Per

Skip to main contentBreadcrumbs Section. Click here to navigate to respective pages.ChapterChapter ‘Actual Lives’ and the Ethic of Accommodation DOI link for ‘Actual Lives’ and the Ethic of Accommodation‘Actual Lives’ and the Ethic of AccommodationByTerry Galloway, Donna Marie Nudd, Carrie SandahlBookThe Community Performance Reader Click here to navigate to parent product. Edition 1st EditionFirst Published 2007Imprint RoutledgePages 8eBook ISBN 9781003060635Share ABSTRACT The first incarnation of the ‘Actual Lives’ writing and performance workshop exclusively for disabled people took place in Austin, Texas, in 1999. From 1999 to 2004, the Austin incarnation of ‘Actual Lives’ created and performed numerous different local and regional productions. The performances would expand to include multimedia and multi-character scenes. The work continues, albeit in two different locations. Austinites Chris and Celia continue working with the ‘Actual Lives’, Austin company. They are looking to conduct the workshops for disabled soldiers returning from Iraq. In US disability legal parlance, an accommodation is an adjustment made to an environment, an attitude or requirement so that a disabled person is able to participate as fully as possible in public life. Accommodation is rooted in a concept of justice and means more than passive non-discrimination; it is a concept that implies action, a requirement to make significant change to both attitudes and architecture.Taylor & Francis Group LogoPoliciesPoliciesPrivacy PolicyTerms & ConditionsCookie PolicyJournalsJournalsTaylor & Francis OnlineCorporateCorporateTaylor & Francis GroupHelp & ContactHelp & ContactStudents/ResearchersLibrarians/InstitutionsConnect with usRegistered in England & Wales No. 3099067 5 Howick Place | London | SW1P 1WG© 2024 Informa UK Limited Back to Top

Just a moment...

a moment...Enable JavaScript and cookies to conti

‘Actual Lives’ and the Ethic of Accommodation | Semantic Scholar

Skip to search formSkip to main contentSkip to account menuSemantic ScholarSemantic Scholar's LogoSearch 217,149,622 papers from all fields of scienceSearchSign InCreate Free AccountDOI:10.4324/9781003060635-33Corpus ID: 225461833‘Actual Lives’ and the Ethic of Accommodation@inproceedings{Galloway2020ActualLA,

title={‘Actual Lives’ and the Ethic of Accommodation},

author={Terry Galloway and Donna Marie Nudd and Carrie Sandahl},

year={2020},

url={https://api.semanticscholar.org/CorpusID:225461833}

}Terry Galloway, Donna Marie Nudd, C. SandahlPublished 24 July 2020PhilosophyView via PublisherSave to LibrarySaveCreate AlertAlertCiteShare1 CitationView AllOne CitationCitation TypeHas PDFAuthorMore FiltersMore FiltersFiltersSort by Most Influenced PapersSort by Citation CountSort by RecencyPutting crip in the script: a critical communication pedagogical study of communication theory textbooksAmin MakkawyShane T. MoremanEducationCommunication Education2019ABSTRACT This critical communication pedagogy study consists of a cripistemological analysis of two prominent communication theory textbooks to better understand the nondisableist assumptions… Expand7SaveRelated PapersShowing 1 through 3 of 0 Related Papers1 CitationRelated PapersStay Connected With Semantic ScholarSign UpWhat Is Semantic Scholar?Semantic Scholar is a free, AI-powered research tool for scientific literature, based at the Allen Institute for AI.Learn MoreAboutAbout UsMeet the TeamPublishersBlog (opens in a new tab)AI2 Careers (opens in a new tab)ProductProduct OverviewSemantic ReaderScholar's HubBeta ProgramRelease NotesAPIAPI OverviewAPI TutorialsAPI Documentation (opens in a new tab)API GalleryResearchPublicationsResearchersResearch CareersPrototypesResourcesHelpFAQLibrariansTutorialsContactProudly built by AI2 (opens in a new tab)Collaborators & Attributions •Terms of Service (opens in a new tab)•Privacy Policy (opens in a new tab)•API License AgreementThe Allen Institute for AI (opens in a new tab)By clicking accept or continuing to use the site, you agree to the terms outlined in our Privacy Policy (opens in a new tab), Terms of Service (opens in a new tab), and Dataset License (opens in a new tab)ACCEPT & CONTINUE

Academic Integrity and Accommodations: The Intersections of Ethics and Flexibility | SpringerLink

Find a journal

Publish with us

Track your research

Cart

Handbook of Academic Integrity pp 1–20Cite as

Home

Handbook of Academic Integrity

Living reference work entry

Academic Integrity and Accommodations: The Intersections of Ethics and Flexibility

Meghan E. Norris2, Tara A. Karasewich2 & Heidi K. Kenkel2

Living reference work entry

First Online: 14 May 2023

118 Accesses

Altmetric

AbstractInstructors face new challenges, and opportunities, in balancing critically important needs for increased flexibility and academic integrity. Rates of students with disability have increased significantly (e.g., Canadian University Survey Consortium, 2013 first-year university student survey: master report. https://cusc-ccreu.ca/wordpress/?page_id=32&lang=en, 2013; 2022 first-year students survey: Master report. https://cusc-ccreu.ca/wordpress/?page_id=32&lang=en, 2022), and especially since the beginning of COVID-19, there have been signs that rates of violations of academic integrity have increased (e.g., Eaton, The intersection of contract academic work and contract cheating: policy brief. Online submission, 2020). A tension exists where instructors must design assessments and courses that are flexible and inclusive for students with diverse needs while ensuring that they are resistant to violations of academic integrity. This chapter reviews accessible course design principles in tandem with academic integrity considerations. Common academic accommodations are also described along with methods for facilitating academic integrity specific to those accommodations.KeywordsAcademic integrityAccessibilityCourse designFlexible designInstructional design

This is a preview of subscription content, log in via an institution.

ReferencesBenson, K. (2021, June 28). In favour of universal design: The argument for continued hybrid online/in-person courses in the wake of the COVID-19 pandemic with a focus on students with disabilities. Person courses in the wake of the COVID-19 pandemic with a focus on students with disabilities.

Google Scholar

Burge, P. (2023, January 9). How to make post-secondary study more accessible? Collaboration between instructors and disability counsellors. The Conversation. https://theconversation.com/how-to-make-post-secondary-study-more-accessible-collaboration-between-instructors-and-disability-counsellors-192488Canadian Human Rights Commission. (2017). Left out: Challenges faced by persons with disabilities in Canada’s schools. https://www.chrc-ccdp.gc.ca/en/resources/publications/left-out-challenges-faced-persons-disabilities-canadas-schoolsCanadian University Survey Consortium. (2013). 2013 first-year university student survey: Master report. https://cusc-ccreu.ca/wordpress/?page_id=32&lang=enCanadian University Survey Consortium. (2022). 2022 first-year students survey: Master report. https://cusc-ccreu.ca/wordpress/?page_id=32&lang=enDavis, M. (2022). Examining and improving inclusive practice in institutional academic integrity policies, procedures, teaching and support. International Journal for Educational Integrity, 18, 14. https://doi.org/10.1007/s40979-022-00108-xArticle

Google Scholar

Deloitte Canada. (2017). Enabling sustained student success support for students at risk in Ontario’s colleges. Retrieved from https://www.collegesontario.org/en/resources/enabling-sustained-student-success. Accessed 27 Jan 2022.Eaton, S. E. (2020). The intersection of contract academic work and contract cheating: Policy brief. Online Submission.

Google Scholar

Eaton, S. E., & Christensen Hughes, J. (2022). Academic integrity in Canada: Historical perspectives and current trends. In Academic integrity in Canada (pp. 3–24). Springer. https://doi.org/10.1007/978-3-030-83255-1_1Harrison, A. G., Holmes, A., & Harrison, K. (2018). Medically confirmed functional impairment as proof of accommodation need in postsecondary education: Are Ontario’s campuses the bellwether of an inequitable decision-making paradigm? Canadian Journal of Educational Administration and Policy, 187, 48–60.

Google Scholar

Higbee, J. L. (2009). Implementing universal instructional design in postsecondary courses and curricula. Journal of College Teaching & Learning (TLC), 6(8), 65–78.Article

Google Scholar

Inclusive Education Canada. (2018). Ontario’s education system is failing students with disabilities. https://inclusiveeducation.ca/2018/02/07/ontarios-education-system-is-failing-students-with-disabilities/. Accessed 27 Jan 2022.Lopez, K. M., & Solano, D. M. (2021). Ethics of cheating: Effects of the COVID-19 pandemic on academic honesty. In International ethics in chemistry: Developing common values across cultures (pp. 63–77). American Chemical Society.

Google Scholar

Ma, J., Pender, M., & Welch, M. (2016). Education pays 2016: The benefits of higher education for individuals and society (Trends in higher education series). College Board.

Google Scholar

Meyer, A., & Rose, D. H. (2000). Universal design for individual differences. Educational Leadership, 58(3), 39–43.

Google Scholar

Miles, P. J., Campbell, M., & Ruxton, G. D. (2022). Why students cheat and how understanding this can help reduce the frequency of academic misconduct in higher education: A literature review. The Journal of Undergraduate Neuroscience Education, 20(2), A150–A159.

Google Scholar

National Disability Authority (n.d.). What is universal design. Centre for Excellence in Universal Design. https://universaldesign.ie/what-is-universal-design/. Accessed 27 Jan 2022.Newton, P., & Essex, K. (2022). How common is cheating in online exams and did it increase during the COVID-19 pandemic? A systematic review. Research Square. https://doi.org/10.21203/rs.3.rs-2187710/v1Oakley, B., Parsons, J., & Wideman, M. (2012). Identifying essential requirements: A guide for university disability service professionals. Inter-University Disabilities Issues Association.

Google Scholar

Ontario Human Rights Commission. (n.d.). Guidelines on accessible education » Appropriate accommodation. https://www.ohrc.on.ca/en/guidelines-accessible-education/appropriate-accommodation. Accessed 27 Jan 2022.Ontario Universities Council on Quality Assurance. (2010). Quality assurance framework. https://oucqa.ca/resources-publications/quality-assurance-framework/Queen’s Student Wellness Services. (2022). Academic Accommodations. https://www.queensu.ca/studentwellness/accessibility-services/academic-accommodations-online-examsRoberts, B., Mohler, C. E., Levy-Pinto, D., Nieder, C., Duffett, E. M., & Sukhai, M. A. (2014). Defining a new culture: Creative examination of essential requirements in academic disciplines and graduate programs. https://www.cags.ca/documents/publications/3rdparty/Discussion%20paper%20Essential%20Requirements%20FINAL%202014-09-22.pdfRose, M. (2010). Accommodating graduate students with disabilities. Council of Ontario Universities academic colleagues working paper, 1–13.

Google Scholar

Scott, S. S., McGuire, J. M., & Foley, T. E. (2003). Universal design for instruction: A framework for anticipating and responding to disability and other diverse learning needs in the college classroom. Equity & Excellence in Education, 36(1), 40–49.

Google Scholar

Svartdal, F., Dahl, T. I., Gamst-Klaussen, T., Koppenborg, M., & Klingsieck, K. B. (2020). How study environments foster academic procrastination: Overview and recommendations. Frontiers in Psychology, 11, 540910.Article

Google Scholar

Thoma, C. A., Bartholomew, C. C., & Scott, L. A. (2009). Universal design for transition: A roadmap for planning and instruction. Brookes Pub.

Google Scholar

Download referencesAuthor informationAuthors and AffiliationsQueen’s University, Kingston, ON, CanadaMeghan E. Norris, Tara A. Karasewich & Heidi K. KenkelAuthorsMeghan E. NorrisView author publicationsYou can also search for this author in

PubMed Google ScholarTara A. KarasewichView author publicationsYou can also search for this author in

PubMed Google ScholarHeidi K. KenkelView author publicationsYou can also search for this author in

PubMed Google ScholarCorresponding authorCorrespondence to

Meghan E. Norris .Editor informationEditors and AffiliationsWerklund School of Education, University of Calgary, Calgary, AB, CanadaSarah Elaine Eaton Section Editor informationThe Centre for the Advancement of Teaching and Learning, University of Manitoba, Winnipeg, CanadaBrenda M. StoeszRights and permissionsReprints and permissionsCopyright information© 2023 Springer Nature Singapore Pte Ltd.About this entryCite this entryNorris, M.E., Karasewich, T.A., Kenkel, H.K. (2023). Academic Integrity and Accommodations: The Intersections of Ethics and Flexibility.

In: Eaton, S.E. (eds) Handbook of Academic Integrity. Springer, Singapore. https://doi.org/10.1007/978-981-287-079-7_92-1Download citation.RIS.ENW.BIBDOI: https://doi.org/10.1007/978-981-287-079-7_92-1Received: 08 March 2023Accepted: 10 March 2023Published: 14 May 2023

Publisher Name: Springer, Singapore

Print ISBN: 978-981-287-079-7

Online ISBN: 978-981-287-079-7eBook Packages: Springer Reference EducationReference Module Humanities and Social SciencesReference Module EducationPublish with usPolicies and ethics

Access via your institution

Search by keyword or author

Navigation

Find a journal

Publish with us

Track your research

Discover content

Journals A-Z

Books A-Z

Publish with us

Publish your research

Open access publishing

Products and services

Our products

Librarians

Societies

Partners and advertisers

Our imprints

Springer

Nature Portfolio

BMC

Palgrave Macmillan

Apress

Your privacy choices/Manage cookies

Your US state privacy rights

Accessibility statement

Terms and conditions

Help and support

49.157.13.121

Not affiliated

Professionalism and the Ethics of Conscientious Objection Accommodation in Medicine | SpringerLink

Find a journal

Publish with us

Track your research

Cart

The Palgrave Handbook of Philosophy and Public Policy pp 609–621Cite as

Home

The Palgrave Handbook of Philosophy and Public Policy

Chapter

Professionalism and the Ethics of Conscientious Objection Accommodation in Medicine

Udo Schuklenk2 & Benjamin Zolf2

Chapter

First Online: 09 October 2018

1415 Accesses

AbstractSome health-care professionals refuse to perform certain services because doing so would violate their conscientiously held beliefs. Arguments for and against their accommodation claims continue both in the public square and in the courts, as well as in bioethics. This chapter introduces this debate by discussing jurisdictions in which accommodation is granted. We offer evidence of the detrimental effects it has on access to health-care services. An overview of influential ethical arguments for and against conscientious objection accommodation, including but not limited to the incompatibility thesis and the moral integrity defense, is presented. We conclude with a discussion of arguments based on the values of diversity and equality of opportunity.

This is a preview of subscription content, log in via an institution.

Buying options

Chapter

EUR 29.95

Price includes VAT (Philippines)

Available as PDF

Read on any device

Instant download

Own it forever

Buy Chapter

eBook

EUR 160.49

Price includes VAT (Philippines)

Available as EPUB and PDF

Read on any device

Instant download

Own it forever

Buy eBook

Softcover Book

EUR 199.99

Price excludes VAT (Philippines)

Compact, lightweight edition

Dispatched in 3 to 5 business days

Free shipping worldwide - see info

Buy Softcover Book

Hardcover Book

EUR 199.99

Price excludes VAT (Philippines)

Durable hardcover edition

Dispatched in 3 to 5 business days

Free shipping worldwide - see info

Buy Hardcover Book

Tax calculation will be finalised at checkout

Purchases are for personal use onlyLearn about institutional subscriptions

Notes1.Mark Wicclair, “Conscientious objection in medicine,” Bioethics 14, no. 3 (July 2000): 205–227.2.Jane Harries, Diane Cooper, Anna Strebel, and Christopher J Colvin, “Conscientious objection and its impact on abortion service provision in South Africa: a qualitative study,” Reproductive Health 11, no. 16 (February 2014): 16. doi: https://doi.org/10.1186/1742-4755-11-163.Wendy Chavkin, Liddy Leitman, Kate Polin, “Conscientious objection and refusal to provide reproductive healthcare: A White Paper examining prevalence, health consequences, and policy responses,” International Journal of Gynecology and Obstetrics 123 (December 2013): 541–556.4.Francesca Minerva. “Conscientious Objection in Italy,” Journal of Medical Ethics 41 (2015): 170–3.5.International Covenant on Civil and Political Rights, adopted December 16, 1966, General Assembly Resolution 2200A(XXI), United Nations GAOR, 21st Session, Supp. No. 16, at 52, U.N. Doc. A/6316 (1966), 999 U.N.T.S. 171.6.Canadian Charter of Rights and Freedoms, s 2a-2b, Part I of the Constitution Act, 1982, being Schedule B to the Canada Act 1982 (UK), 1982, c 11.7.Reynolds v. United States, 98 U.S. 145 (1878).8.Douglas NeJaime and Reva B. Siegel, “Conscience Wars: Complicity-Based Conscience Claims in Religion and Politics,” Yale Law Journal 124, no. 7 (May 2015): 2516–2591, at 2566.9.Pichon and Sajous v France, 2001-X Eur. Ct. H.R.10.Christina Zampas and Ximena Andión-Ibañez, “Conscientious Objection to Sexual and Reproductive Health Services: International Human Rights Standards and European Law and Practice,” European Journal of Health Law 19 (2012): 231–256, at 241.11.NeJaime and Siegel, “Conscience Wars: Complicity-Based Conscience Claims,” 2533.12.Zampas, C, Ximena, A-I (2012), Ibid.13.Roger Trigg, “Conscientious Objection and ‘Effective Referral’,” Cambridge Quarterly of Healthcare Ethics 26, no. 1 (December 2016): 32–43.14.Christian Munthe, “Conscientious refusal in healthcare: the Swedish solution,” Journal of Medical Ethics 43 (September 2016): 257–259.15.Chavkin, Leitman, and Polin, “Conscientious objection and refusal to provide reproductive healthcare,” 541–556.16.Douglas NeJaime and Reva Siegel, “Conscience Wars in Transnational Perspective: Religious Liberty, Third-Party Harm, and Pluralism,” in The Conscience Wars: Rethinking the Balance Between Religion, Identity, and Equality, eds. Susanna Mancini and Michael Rosenfeld (Cambridge: Cambridge University Press, forthcoming).17.Edmund Pellegrino, “The physician’s conscience, conscience clauses, and religious belief: a Catholic perspective,” Fordham Urban Law Journal 30 (November 2002): 221–44.18.Daniel Weinstock, “Conscientious refusal and healthcare professionals: does religion make a difference?” Bioethics 28, no. 1 (January 2014)L: 8–15.19.James F. Childress, “Appeals to Conscience,” Ethics 74, no.4 (July 1979): 315–335.20.Daniel P. Sulmasy, “What is conscience, and why is respect for it so important?” Theoretical Medicine and Bioethics 29, no. 3 (June 2008): 135–4.21.Mark Wicclair, Conscientious Objection in Health Care: An Ethical Analysis (Cambridge: Cambridge University Press, 2011).22.Mark Wicclair, “Conscientious Objection in Healthcare and Moral Integrity,” Cambridge Quarterly of Healthcare Ethics 26, no. 1 (December 2016): 7–17.23.Ibid.24.Robert Card, “Conscientious Objection and Emergency Contraception,” The American Journal of Bioethics 7, no. 6 (June 2007): 8–14.25.Robert Card, “The Inevitability of Assessing Reasons in Debates about Conscientious Objection in Medicine,” Cambridge Quarterly of Healthcare Ethics 26, no. 1 (December 2016): 82–96.26.Robert Card, “Reasonability and conscientious objection: a reply to Marsh and an elaboration of the reason-giving requirement,” Bioethics 28, no. 6 (July 2014): 320–326.27.Alida Liberman, “Wrongness, responsibility, and conscientious refusal in health care,” Bioethics 31, no. 7 (September 2017): 495–504.28.Wicclair, “Conscientious Objection in Healthcare and Moral Integrity,” 13.29.Trigg, “Conscientious Objection,” 40.30.Jason Marsh, “Conscientious refusals and reason-giving,” Bioethics 28, no. 6 (July 2014): 313–319, at 316.31.Ibid., at 317.32.Benjamin Zolf, “No Conscientious Objection without Normative Justification: Against Conscientious Objection in Medicine,” Bioethics 2018 (in press). 33.Smith: Employment Division, Department of Human Resources of Oregon v. Smith, [1990] 494 US 872.34.Amselem: Syndicat Northcrest v Amselem, [2004] 2 SCR 551 2004 SCC 47.35.Kelly Grant, “Canadian doctors turn away from assisted dying over fees,” Globe and Mail, July 3, 2017, https://beta.theglobeandmail.com/news/national/payment-complications-turning-canadian-doctors-away-from-assisted-dying/article35538666/ [Accessed October 29, 2017].36.Christopher Meyers and Robert D. Woods, “Conscientious objection? Yes, but make sure it is genuine,” The American Journal of Bioethics 7, no. 6 (June 2007): 19–20.37.Lori Kantymir and Carolyn Mcleod, “Justification for Conscience Exemptions in Health Care,” Bioethics 28, no. 1 (September 2013): 16–23.38.Udo Schuklenk and Ricardo Smalling, “Why medical professionals have no moral claim to conscientious objection accommodation in liberal democracies,” Journal of Medical Ethics 43, no. 4 (April 2017): 234–240.39.Jocelyn Maclure and Isabelle Dumont, “Selling conscience short: a response to Schuklenk and Smalling on conscientious objections by medical professionals,” Journal of Medical Ethics 43, no. 4 (April 2017): 241–244.40.Schuklenk and Smalling, “Why medical professionals have no moral claim to conscientious objection accommodation in liberal democracies,” 236.41.Julian Savulescu, “Conscientious objection in medicine,” British Medical Journal 332, (February 2006): 294–297.42.Julian Savulescu and Udo Schuklenk, “Doctors have no right to refuse medical assistance in dying, abortion, or contraception,” Bioethics 31, no. 3 (March 2017): 162–170.43.Rosamond Rhodes, “The ethical standard of care,” American Journal of Bioethics 6, no. 2 (August 2006): 76–78.44.Ibid., 77.45.Savulescu and Schuklenk, “Doctors have no right to refuse,” 162–170.46.Schuklenk and Smalling, “Why medical professionals have no moral claim to conscientious objection accommodation in liberal democracies,” 234.47.Christopher Cowley, “A defence of conscientious objection in medicine: a reply to Schuklenk and Savulescu,” Bioethics 30, no. 5 (June 2016): 358–364.48.Christian Munthe, “Conscientious refusal in healthcare,” 257–259.49.Mark Wicclair, (2008) “Is conscientious objection incompatible with a physician’s professional obligations?” Theoretical Medicine and Bioethics 29, no. 3 (June 2008): 171–185.50.Trigg, “Conscientious Objection,” 32–43.51.Ibid., 34.52.Jeff Blackmer, “Clarification of the CMA’s position concerning induced abortion,” Canadian Medical Association Journal 176, no. 9 (April 2007): 1310.53.American Medical Association Council on Ethics and Judicial Affairs (2014) Physician Exercise of Conscience. https://www.ama-assn.org/sites/default/files/media-browser/public/about-ama/councils/Council%20Reports/council-on-ethics-and-judicial-affairs/i14-ceja-physician-exercise-conscience.pdf [Accessed October 29, 2017].54.NeJaime and Siegel, “Conscience wars: Complicity-Based Conscience Claims,” 2566–7.55.Jonathan Hughes, “Conscientious objection, professional duty and compromise: A response to Savulescu and Schuklenk,” Bioethics 32, no. 1 (February 2018): 126–131. https://doi.org/10.1111/bioe.1241056.Maclure and Dumont, “Selling conscience short,” 243.57.Schuklenk and Smalling, “Why medical professionals have no moral claim to conscientious objection accommodation in liberal democracies,” 239.58.Daniel P. Sulmasy, “Tolerance, professional judgment, and the discretionary space of the physician,” Cambridge Quarterly of Healthcare Ethics 26, no. 1 (December 2016): 22.59.Trigg, “Conscientious Objection,” 34.60.Savulescu and Schuklenk, “Doctors have no right to refuse,” 166.61.Richard John Lyus, “Response to: ‘Why medical professionals have no moral claim to conscientious objection accommodation in liberal democracies’ by Schuklenk and Smalling,” Journal of Medical Ethics 43, no. 4 (April 2017): 250–252.62.Udo Schuklenk and Ricardo Smalling, “Against the accommodation of subjective healthcare provider beliefs in medicine: counteracting supporters of conscientious objector accommodation arguments,” Journal of Medical Ethics 43, no. 4 (April 2017): 253–256, at 255.63.Ibid., at 256.Author informationAuthors and AffiliationsQueen’s University, Kingston, ON, CanadaUdo Schuklenk & Benjamin ZolfAuthorsUdo SchuklenkView author publicationsYou can also search for this author in

PubMed Google ScholarBenjamin ZolfView author publicationsYou can also search for this author in

PubMed Google ScholarEditor informationEditors and AffiliationsUniversity of Colorado Boulder, Boulder, CO, USADavid Boonin Rights and permissionsReprints and permissionsCopyright information© 2018 The Author(s)About this chapterCite this chapterSchuklenk, U., Zolf, B. (2018). Professionalism and the Ethics of Conscientious Objection Accommodation in Medicine.

In: Boonin, D. (eds) The Palgrave Handbook of Philosophy and Public Policy. Palgrave Macmillan, Cham. https://doi.org/10.1007/978-3-319-93907-0_46Download citation.RIS.ENW.BIBDOI: https://doi.org/10.1007/978-3-319-93907-0_46Published: 09 October 2018

Publisher Name: Palgrave Macmillan, Cham

Print ISBN: 978-3-319-93906-3

Online ISBN: 978-3-319-93907-0eBook Packages: Religion and PhilosophyPhilosophy and Religion (R0)Share this chapterAnyone you share the following link with will be able to read this content:Get shareable linkSorry, a shareable link is not currently available for this article.Copy to clipboard

Provided by the Springer Nature SharedIt content-sharing initiative

Publish with usPolicies and ethics

Access via your institution

Buying options

Chapter

EUR 29.95

Price includes VAT (Philippines)

Available as PDF

Read on any device

Instant download

Own it forever

Buy Chapter

eBook

EUR 160.49

Price includes VAT (Philippines)

Available as EPUB and PDF

Read on any device

Instant download

Own it forever

Buy eBook

Softcover Book

EUR 199.99

Price excludes VAT (Philippines)

Compact, lightweight edition

Dispatched in 3 to 5 business days

Free shipping worldwide - see info

Buy Softcover Book

Hardcover Book

EUR 199.99

Price excludes VAT (Philippines)

Durable hardcover edition

Dispatched in 3 to 5 business days

Free shipping worldwide - see info

Buy Hardcover Book

Tax calculation will be finalised at checkout

Purchases are for personal use onlyLearn about institutional subscriptions

Search by keyword or author

Navigation

Find a journal

Publish with us

Track your research

Discover content

Journals A-Z

Books A-Z

Publish with us

Publish your research

Open access publishing

Products and services

Our products

Librarians

Societies

Partners and advertisers

Our imprints

Springer

Nature Portfolio

BMC

Palgrave Macmillan

Apress

Your privacy choices/Manage cookies

Your US state privacy rights

Accessibility statement

Terms and conditions

Help and support

49.157.13.121

Not affiliated

The trouble with families: toward an ethic of accommodation - PubMed

This site needs JavaScript to work properly. Please enable it to take advantage of the complete set of features!

Clipboard, Search History, and several other advanced features are temporarily unavailable.

Skip to main page content

An official website of the United States government

Here's how you know

The .gov means it’s official.

Federal government websites often end in .gov or .mil. Before

sharing sensitive information, make sure you’re on a federal

government site.

The site is secure.

The https:// ensures that you are connecting to the

official website and that any information you provide is encrypted

and transmitted securely.

Show account info

Account

Logged in as:

username

Dashboard

Publications

Account settings

Log out

Access keys

NCBI Homepage

MyNCBI Homepage

Main Content

Main Navigation

Search:

Advanced

Clipboard

User Guide

Save

Send to

Clipboard

My BibliographyCollectionsCitation manager

Display options

Format

Abstract

PubMed

PMID

Save citation to file

Format:

Summary (text)

PubMed

PMID

Abstract (text)

CSV

Create file

Cancel

Email citation

Subject:

1 selected item: 10068362 - PubMed

To:

From:

Format:

Summary

Summary (text)

Abstract

Abstract (text)

MeSH and other data

Send email

Cancel

Add to Collections

Create a new collection

Add to an existing collection

Name your collection:

Name must be less than 100 characters

Choose a collection:

Unable to load your collection due to an error

Please try again

Add

Cancel

Add to My Bibliography

My Bibliography

Unable to load your delegates due to an error

Please try again

Add

Cancel

Your saved search

Name of saved search:

Search terms:

Test search terms

Would you like email updates of new search results?

Saved Search Alert Radio Buttons

Yes

Email:

(change)

Frequency:

Monthly

Weekly

Daily

Which day?

The first Sunday

The first Monday

The first Tuesday

The first Wednesday

The first Thursday

The first Friday

The first Saturday

The first day

The first weekday

Which day?

Sunday

Monday

Tuesday

Wednesday

Thursday

Friday

Saturday

Report format:

Summary

Summary (text)

Abstract

Abstract (text)

PubMed

Send at most:

1 item

5 items

10 items

20 items

50 items

100 items

200 items

Send even when there aren't any new results

Optional text in email:

Save

Cancel

Create a file for external citation management software

Create file

Cancel

Your RSS Feed

Name of RSS Feed:

Number of items displayed:

100

Create RSS

Cancel

RSS Link

Copy

Full text links

Atypon

Full text links

ActionsCiteCollectionsAdd to CollectionsCreate a new collectionAdd to an existing collection

Name your collection:

Name must be less than 100 characters

Choose a collection:

Unable to load your collection due to an errorPlease try again

Add

Cancel

Display options

Format

AbstractPubMedPMID

Permalink

Copy

Page navigation

Title & authors

Abstract

Similar articles

Cited by

Publication types

MeSH terms

Related information

LinkOut - more resources

Title & authors

Abstract

Similar articles

Cited by

Publication types

MeSH terms

Related information

LinkOut - more resources

Ann Intern Med

Actions

Search in PubMed

Search in NLM Catalog

Add to Search

. 1999 Jan 19;130(2):148-52.

doi: 10.7326/0003-4819-130-2-199901190-00010.

The trouble with families: toward an ethic of accommodation

C Levine

, C Zuckerman

Affiliations

Expand

Affiliation

1 Beth Israel Medical Center, New York, New York 10003, USA.

PMID:

10068362

DOI:

10.7326/0003-4819-130-2-199901190-00010

Item in Clipboard

The trouble with families: toward an ethic of accommodation

C Levine et al.

Ann Intern Med.

1999.

Show details

Display options

Format

Abstract

PubMed

PMID

Ann Intern Med

Actions

Search in PubMed

Search in NLM Catalog

Add to Search

. 1999 Jan 19;130(2):148-52.

doi: 10.7326/0003-4819-130-2-199901190-00010.

Authors

C Levine

, C Zuckerman

Affiliation

1 Beth Israel Medical Center, New York, New York 10003, USA.

PMID:

10068362

DOI:

10.7326/0003-4819-130-2-199901190-00010

Item in Clipboard

Full text links

CiteDisplay options

Display options

Format

AbstractPubMedPMID

Abstract

Although some clinicians are extraordinarily sensitive to the legitimate roles of patients' families in medical crises, a persistent tendency to equate families with trouble is evident in both the literature and the practice of medicine. Some negative presumptions about families derive from western medicine's almost exclusive focus on the individual patient in codes of ethics, training, and practice. Modern bioethics has reinforced this individualistic approach. Physicians' primary responsibilities are unequivocally to their patients, but a complete understanding of the patient's personhood must include consideration of the significant persons who help define the patient's core identity. One source of tension between professionals and families lies in differing perceptions of the roles that family members should play and how they should play them. Members of a family may act as advocates, provide or manage care, serve as trusted companions on the journey through illness and death, and make decisions on behalf of an incompetent patient. Each role presents potential conflicts. Other sources of conflict include disagreement within a family; challenges to physician authority; fear of litigation; and differing religious, ethnic, or cultural traditions. An ethic of accommodation emphasizes the need to negotiate care plans that do not compromise patients' basic interests but that recognize the capacities and limitations of family members. Family caregivers want understandable and timely information, better training, compassionate recognition of their anxiety, guidance in defining their roles and responsibilities, and support for the setting of fair limits on their sacrifices. Health care professionals can better meet these needs through education and skills acquisition, the establishment of partnerships with families, and regular dialogue and communication.

PubMed Disclaimer

Similar articles

Hands on/hands off: why health care professionals depend on families but keep them at arm's length.

Levine C, Zuckerman C.

Levine C, et al.

J Law Med Ethics. 2000 Spring;28(1):5-18, 2. doi: 10.1111/j.1748-720x.2000.tb00311.x.

J Law Med Ethics. 2000.

PMID: 11067632

Review.

The patient experience of patient-centered communication with nurses in the hospital setting: a qualitative systematic review protocol.

Newell S, Jordan Z.

Newell S, et al.

JBI Database System Rev Implement Rep. 2015 Jan;13(1):76-87. doi: 10.11124/jbisrir-2015-1072.

JBI Database System Rev Implement Rep. 2015.

PMID: 26447009

[The analysis of physicians' work: announcing the end of attempts at in vitro fertilization].

Santiago-Delefosse M, Cahen F, Coeffin-Driol C.

Santiago-Delefosse M, et al.

Encephale. 2003 Jul-Aug;29(4 Pt 1):293-305.

Encephale. 2003.

PMID: 14615699

French.

A framework for resolving disagreement during end of life care in the critical care unit.

Choong K, Cupido C, Nelson E, Arnold DM, Burns K, Cook D, Meade M; ACCADEMY.

Choong K, et al.

Clin Invest Med. 2010 Aug 1;33(4):E240-53. doi: 10.25011/cim.v33i4.14227.

Clin Invest Med. 2010.

PMID: 20691142

Physician-family partnerships: the adaptive practice model.

Feldman HM, Ploof D, Cohen WI.

Feldman HM, et al.

J Dev Behav Pediatr. 1999 Apr;20(2):111-6. doi: 10.1097/00004703-199904000-00007.

J Dev Behav Pediatr. 1999.

PMID: 10219690

Review.

See all similar articles

Cited by

Reframing Mental Health Ethics.

Knopes J, Guidry-Grimes L.

Knopes J, et al.

Community Ment Health J. 2024 Feb;60(2):208-214. doi: 10.1007/s10597-023-01189-9. Epub 2023 Oct 3.

Community Ment Health J. 2024.

PMID: 37787887

The role of caregivers in the clinical pathway of patients newly diagnosed with breast and prostate cancer: A study protocol.

Cincidda C, Oliveri S, Sanchini V, Pravettoni G.

Cincidda C, et al.

Front Psychol. 2022 Nov 2;13:962634. doi: 10.3389/fpsyg.2022.962634. eCollection 2022.

Front Psychol. 2022.

PMID: 36405193

Free PMC article.

Young Adults and Their Families Living With Mental Illness: Evaluation of the Usefulness of Family-Centered Support Conversations in Community Mental Health care Settings.

Aass LK, Skundberg-Kletthagen H, Schrøder A, Moen ØL.

Aass LK, et al.

J Fam Nurs. 2020 Nov;26(4):302-314. doi: 10.1177/1074840720964397. Epub 2020 Oct 23.

J Fam Nurs. 2020.

PMID: 33095093

Free PMC article.

Patient and Family Descriptions of Ethical Concerns.

Cho HL, Grady C, Tarzian A, Povar G, Mangal J, Danis M.

Cho HL, et al.

Am J Bioeth. 2020 Jun;20(6):52-64. doi: 10.1080/15265161.2020.1754500.

Am J Bioeth. 2020.

PMID: 32441594

Free PMC article.

Family Caregivers' Experiences With Health Care Workers in the Care of Older Adults With Activity Limitations.

Wolff JL, Freedman VA, Mulcahy JF, Kasper JD.

Wolff JL, et al.

JAMA Netw Open. 2020 Jan 3;3(1):e1919866. doi: 10.1001/jamanetworkopen.2019.19866.

JAMA Netw Open. 2020.

PMID: 31977063

Free PMC article.

See all "Cited by" articles

Publication types

Research Support, Non-U.S. Gov't

Actions

Search in PubMed

Search in MeSH

Add to Search

MeSH terms

Caregivers

Actions

Search in PubMed

Search in MeSH

Add to Search

Communication

Actions

Search in PubMed

Search in MeSH

Add to Search

Conflict, Psychological

Actions

Search in PubMed

Search in MeSH

Add to Search

Dissent and Disputes

Actions

Search in PubMed

Search in MeSH

Add to Search

Ethics, Medical*

Actions

Search in PubMed

Search in MeSH

Add to Search

Family / psychology

Actions

Search in PubMed

Search in MeSH

Add to Search

Group Processes

Actions

Search in PubMed

Search in MeSH

Add to Search

Humans

Actions

Search in PubMed

Search in MeSH

Add to Search

Physician-Patient Relations

Actions

Search in PubMed

Search in MeSH

Add to Search

Professional-Family Relations*

Actions

Search in PubMed

Search in MeSH

Add to Search

Related information

Cited in Books

LinkOut - more resources

Full Text Sources

Atypon

Ovid Technologies, Inc.

Medical

MedlinePlus Health Information

Full text links

[x]

Atypon

[x]

Cite

Copy

Download .nbib

.nbib

Format:

AMA

APA

MLA

NLM

Send To

Clipboard

Save

My Bibliography

Collections

Citation Manager

[x]

NCBI Literature Resources

MeSH

PMC

Bookshelf

Disclaimer

The PubMed wordmark and PubMed logo are registered trademarks of the U.S. Department of Health and Human Services (HHS). Unauthorized use of these marks is strictly prohibited.

Follow NCBI

Twitter

Facebook

GitHub

Connect with NLM

Twitter

SM-Facebook

SM-Youtube

National Library of Medicine

8600 Rockville Pike

Bethesda, MD 20894

Web Policies

FOIA

HHS Vulnerability Disclosure

Help

Accessibility

Careers

NLM

NIH

HHS

USA.gov

Page restricted | ScienceDirect

Your Browser is out of date.

Update your browser to view ScienceDirect.

View recommended browsers.

Request details:

Request ID: 86446820bd9b04f4-HKG

IP: 49.157.13.121

UTC time: 2024-03-14T12:53:27+00:00

Browser: Mozilla/5.0 (Windows NT 10.0; Win64; x64) AppleWebKit/537.36 (KHTML, like Gecko) Chrome/97.0.4692.71 Safari/537.36

About ScienceDirect

Shopping cart

Contact and support

Terms and conditions

Cookies are used by this site. By continuing you agree to the use of cookies.

Copyright Â© 2024 Elsevier B.V., its licensors, and contributors. All rights are reserved, including those for text and data mining, AI training, and similar technologies. For all open access content, the Creative Commons licensing terms apply.

Page restricted | ScienceDirect

Your Browser is out of date.

Update your browser to view ScienceDirect.

View recommended browsers.

Request details:

Request ID: 86446820ce931081-HKG

IP: 49.157.13.121

UTC time: 2024-03-14T12:53:27+00:00

Browser: Mozilla/5.0 (Windows NT 10.0; Win64; x64) AppleWebKit/537.36 (KHTML, like Gecko) Chrome/97.0.4692.71 Safari/537.36

About ScienceDirect

Shopping cart

Contact and support

Terms and conditions

Cookies are used by this site. By continuing you agree to the use of cookies.

Page restricted | ScienceDirect

Your Browser is out of date.

Update your browser to view ScienceDirect.

View recommended browsers.

Request details:

Request ID: 86446820bac0107b-HKG

IP: 49.157.13.121

UTC time: 2024-03-14T12:53:27+00:00

Browser: Mozilla/5.0 (Windows NT 10.0; Win64; x64) AppleWebKit/537.36 (KHTML, like Gecko) Chrome/97.0.4692.71 Safari/537.36

About ScienceDirect

Shopping cart

Contact and support

Terms and conditions

Cookies are used by this site. By continuing you agree to the use of cookies.

Page restricted | ScienceDirect

Your Browser is out of date.

Update your browser to view ScienceDirect.

View recommended browsers.

Request details:

Request ID: 86446820df590449-HKG

IP: 49.157.13.121

UTC time: 2024-03-14T12:53:27+00:00

Browser: Mozilla/5.0 (Windows NT 10.0; Win64; x64) AppleWebKit/537.36 (KHTML, like Gecko) Chrome/97.0.4692.71 Safari/537.36

About ScienceDirect

Shopping cart

Contact and support

Terms and conditions

Cookies are used by this site. By continuing you agree to the use of cookies.

The trouble with families: toward an ethic of accommodation - PubMed

This site needs JavaScript to work properly. Please enable it to take advantage of the complete set of features!

Clipboard, Search History, and several other advanced features are temporarily unavailable.

Skip to main page content

An official website of the United States government

Here's how you know

The .gov means it’s official.

Federal government websites often end in .gov or .mil. Before

sharing sensitive information, make sure you’re on a federal

government site.

The site is secure.

The https:// ensures that you are connecting to the

official website and that any information you provide is encrypted

and transmitted securely.

Show account info

Account

Logged in as:

username

Dashboard

Publications

Account settings

Log out

Access keys

NCBI Homepage

MyNCBI Homepage

Main Content

Main Navigation

Search:

Advanced

Clipboard

User Guide

Save

Send to

Clipboard

My BibliographyCollectionsCitation manager

Display options

Format

Abstract

PubMed

PMID

Save citation to file

Format:

Summary (text)

PubMed

PMID

Abstract (text)

CSV

Create file

Cancel

Email citation

Subject:

1 selected item: 10068362 - PubMed

To:

From:

Format:

Summary

Summary (text)

Abstract

Abstract (text)

MeSH and other data

Send email

Cancel

Add to Collections

Create a new collection

Add to an existing collection

Name your collection:

Name must be less than 100 characters

Choose a collection:

Unable to load your collection due to an error

Please try again

Add

Cancel

Add to My Bibliography

My Bibliography

Unable to load your delegates due to an error

Please try again

Add

Cancel

Your saved search

Name of saved search:

Search terms:

Test search terms

Would you like email updates of new search results?

Saved Search Alert Radio Buttons

Yes

Email:

(change)

Frequency:

Monthly

Weekly

Daily

Which day?

The first Sunday

The first Monday

The first Tuesday

The first Wednesday

The first Thursday

The first Friday

The first Saturday

The first day

The first weekday

Which day?

Sunday

Monday

Tuesday

Wednesday

Thursday

Friday

Saturday

Report format:

Summary

Summary (text)

Abstract

Abstract (text)

PubMed

Send at most:

1 item

5 items

10 items

20 items

50 items

100 items

200 items

Send even when there aren't any new results

Optional text in email:

Save

Cancel

Create a file for external citation management software

Create file

Cancel

Your RSS Feed

Name of RSS Feed:

Number of items displayed:

100

Create RSS

Cancel

RSS Link

Copy

Full text links

Atypon

Full text links

ActionsCiteCollectionsAdd to CollectionsCreate a new collectionAdd to an existing collection

Name your collection:

Name must be less than 100 characters

Choose a collection:

Unable to load your collection due to an errorPlease try again

Add

Cancel

Display options

Format

AbstractPubMedPMID

Permalink

Copy

Page navigation

Title & authors

Abstract

Similar articles

Cited by

Publication types

MeSH terms

Related information

LinkOut - more resources

Title & authors

Abstract

Similar articles

Cited by

Publication types

MeSH terms

Related information

LinkOut - more resources

Ann Intern Med

Actions

Search in PubMed

Search in NLM Catalog

Add to Search

. 1999 Jan 19;130(2):148-52.

doi: 10.7326/0003-4819-130-2-199901190-00010.

The trouble with families: toward an ethic of accommodation

C Levine

, C Zuckerman

Affiliations

Expand

Affiliation

1 Beth Israel Medical Center, New York, New York 10003, USA.

PMID:

10068362

DOI:

10.7326/0003-4819-130-2-199901190-00010

Item in Clipboard

The trouble with families: toward an ethic of accommodation

C Levine et al.

Ann Intern Med.

1999.

Show details

Display options

Format

Abstract

PubMed

PMID

Ann Intern Med

Actions

Search in PubMed

Search in NLM Catalog

Add to Search

. 1999 Jan 19;130(2):148-52.

doi: 10.7326/0003-4819-130-2-199901190-00010.

Authors

C Levine

, C Zuckerman

Affiliation

1 Beth Israel Medical Center, New York, New York 10003, USA.

PMID:

10068362

DOI:

10.7326/0003-4819-130-2-199901190-00010

Item in Clipboard

Full text links

CiteDisplay options

Display options

Format

AbstractPubMedPMID

Abstract

PubMed Disclaimer

Similar articles

Hands on/hands off: why health care professionals depend on families but keep them at arm's length.

Levine C, Zuckerman C.

Levine C, et al.

J Law Med Ethics. 2000 Spring;28(1):5-18, 2. doi: 10.1111/j.1748-720x.2000.tb00311.x.

J Law Med Ethics. 2000.

PMID: 11067632

Review.

The patient experience of patient-centered communication with nurses in the hospital setting: a qualitative systematic review protocol.

Newell S, Jordan Z.

Newell S, et al.

JBI Database System Rev Implement Rep. 2015 Jan;13(1):76-87. doi: 10.11124/jbisrir-2015-1072.

JBI Database System Rev Implement Rep. 2015.

PMID: 26447009

[The analysis of physicians' work: announcing the end of attempts at in vitro fertilization].

Santiago-Delefosse M, Cahen F, Coeffin-Driol C.

Santiago-Delefosse M, et al.

Encephale. 2003 Jul-Aug;29(4 Pt 1):293-305.

Encephale. 2003.

PMID: 14615699

French.

A framework for resolving disagreement during end of life care in the critical care unit.

Choong K, Cupido C, Nelson E, Arnold DM, Burns K, Cook D, Meade M; ACCADEMY.

Choong K, et al.

Clin Invest Med. 2010 Aug 1;33(4):E240-53. doi: 10.25011/cim.v33i4.14227.

Clin Invest Med. 2010.

PMID: 20691142

Physician-family partnerships: the adaptive practice model.

Feldman HM, Ploof D, Cohen WI.

Feldman HM, et al.

J Dev Behav Pediatr. 1999 Apr;20(2):111-6. doi: 10.1097/00004703-199904000-00007.

J Dev Behav Pediatr. 1999.

PMID: 10219690

Review.

See all similar articles

Cited by

Reframing Mental Health Ethics.

Knopes J, Guidry-Grimes L.

Knopes J, et al.

Community Ment Health J. 2024 Feb;60(2):208-214. doi: 10.1007/s10597-023-01189-9. Epub 2023 Oct 3.

Community Ment Health J. 2024.

PMID: 37787887

The role of caregivers in the clinical pathway of patients newly diagnosed with breast and prostate cancer: A study protocol.

Cincidda C, Oliveri S, Sanchini V, Pravettoni G.

Cincidda C, et al.

Front Psychol. 2022 Nov 2;13:962634. doi: 10.3389/fpsyg.2022.962634. eCollection 2022.

Front Psychol. 2022.

PMID: 36405193

Free PMC article.

Young Adults and Their Families Living With Mental Illness: Evaluation of the Usefulness of Family-Centered Support Conversations in Community Mental Health care Settings.

Aass LK, Skundberg-Kletthagen H, Schrøder A, Moen ØL.

Aass LK, et al.

J Fam Nurs. 2020 Nov;26(4):302-314. doi: 10.1177/1074840720964397. Epub 2020 Oct 23.

J Fam Nurs. 2020.

PMID: 33095093

Free PMC article.

Patient and Family Descriptions of Ethical Concerns.

Cho HL, Grady C, Tarzian A, Povar G, Mangal J, Danis M.

Cho HL, et al.

Am J Bioeth. 2020 Jun;20(6):52-64. doi: 10.1080/15265161.2020.1754500.

Am J Bioeth. 2020.

PMID: 32441594

Free PMC article.

Family Caregivers' Experiences With Health Care Workers in the Care of Older Adults With Activity Limitations.

Wolff JL, Freedman VA, Mulcahy JF, Kasper JD.

Wolff JL, et al.

JAMA Netw Open. 2020 Jan 3;3(1):e1919866. doi: 10.1001/jamanetworkopen.2019.19866.

JAMA Netw Open. 2020.

PMID: 31977063

Free PMC article.

See all "Cited by" articles

Publication types

Research Support, Non-U.S. Gov't

Actions

Search in PubMed

Search in MeSH

Add to Search

MeSH terms

Caregivers

Actions

Search in PubMed

Search in MeSH

Add to Search

Communication

Actions

Search in PubMed

Search in MeSH

Add to Search

Conflict, Psychological

Actions

Search in PubMed

Search in MeSH

Add to Search

Dissent and Disputes

Actions

Search in PubMed

Search in MeSH

Add to Search

Ethics, Medical*

Actions

Search in PubMed

Search in MeSH

Add to Search

Family / psychology

Actions

Search in PubMed

Search in MeSH

Add to Search

Group Processes

Actions

Search in PubMed

Search in MeSH

Add to Search

Humans

Actions

Search in PubMed

Search in MeSH

Add to Search

Physician-Patient Relations

Actions

Search in PubMed

Search in MeSH

Add to Search

Professional-Family Relations*

Actions

Search in PubMed

Search in MeSH

Add to Search

Related information

Cited in Books

LinkOut - more resources

Full Text Sources

Atypon

Ovid Technologies, Inc.

Medical

MedlinePlus Health Information

Full text links

[x]

Atypon

[x]

Cite

Copy

Download .nbib

.nbib

Format:

AMA

APA

MLA

NLM

Send To

Clipboard

Save

My Bibliography

Collections

Citation Manager

[x]

NCBI Literature Resources

MeSH

PMC

Bookshelf

Disclaimer

The PubMed wordmark and PubMed logo are registered trademarks of the U.S. Department of Health and Human Services (HHS). Unauthorized use of these marks is strictly prohibited.

Follow NCBI

Twitter

Facebook

GitHub

Connect with NLM

Twitter

SM-Facebook

SM-Youtube

National Library of Medicine

8600 Rockville Pike

Bethesda, MD 20894

Web Policies

FOIA

HHS Vulnerability Disclosure

Help

Accessibility

Careers

NLM

NIH

HHS

USA.gov

Page restricted | ScienceDirect

Your Browser is out of date.

Update your browser to view ScienceDirect.

View recommended browsers.

Request details:

Request ID: 86446820bd42848b-HKG

IP: 49.157.13.121

UTC time: 2024-03-14T12:53:27+00:00

Browser: Mozilla/5.0 (Windows NT 10.0; Win64; x64) AppleWebKit/537.36 (KHTML, like Gecko) Chrome/97.0.4692.71 Safari/537.36

About ScienceDirect

Shopping cart

Contact and support

Terms and conditions

Cookies are used by this site. By continuing you agree to the use of cookies.

Feminist Ethics of Care, Responsibility, and Refugee Accommodation: Concrete Steps Toward Improvements | SpringerLink

Find a journal

Publish with us

Track your research

Cart

Refugee Camps in Europe and Australia pp 121–136Cite as

Home

Refugee Camps in Europe and Australia

Chapter

Feminist Ethics of Care, Responsibility, and Refugee Accommodation: Concrete Steps Toward Improvements

Yudit Namer5

Chapter

First Online: 09 October 2022

271 Accesses

AbstractThe “duty of care” is a legal concept referring to the obligation to abide by a specified standard of care, defined in a particular legal system or professional domain, when there is potential for causing harm. Institutions such as social services or medical facilities as well as detention centers and prisons have standards of care set by states or international treaties that describe how harm to people whose care they are responsible for should be avoided in the first place. The realities of offshore immigration detention and immobilizing, camp-like refugee accommodation have made standards of care (or lack thereof), and in turn, duties of care, urgent loci of discussion. This chapter applies a feminist ethics of care lens to this discussion and suggests concrete steps informed by this lens toward improving refugee accommodation.KeywordsCampRefugee campFeminist ethics of careInterventionSocial scienceMental healthEuropeAustraliaLawDuty of care

This is a preview of subscription content, log in via an institution.

Buying options

Chapter

EUR 29.95

Price includes VAT (Philippines)

Available as PDF

Read on any device

Instant download

Own it forever

Buy Chapter

eBook

EUR 32.09

Price includes VAT (Philippines)

Available as EPUB and PDF

Read on any device

Instant download

Own it forever

Buy eBook

Hardcover Book

EUR 39.99

Price excludes VAT (Philippines)

Durable hardcover edition

Dispatched in 3 to 5 business days

Free shipping worldwide - see info

Buy Hardcover Book

Tax calculation will be finalised at checkout

Purchases are for personal use onlyLearn about institutional subscriptions

ReferencesAhmed, S. (2014). Self-Care as Warfare. Feministkilljoys. Retrieved on December 8, 2021 from https://feministkilljoys.com/2014/08/25/selfcare-as-warfare/Barghadouch, A., Norredam, M., & Skovdal, M. (2020). The Care Ethics of Child Health Nurses in Danish Asylum Centers: An Ethnographic Study. Global Qualitative Nursing Research, 7, 233339362098414. https://doi.org/10.1177/2333393620984141Article

Google Scholar

Benyera, E. (2019). Borders and the Coloniality of Human Mobility. In I. Moyo & C.C. Nshimbi (Eds.), African Borders, Conflict, Regional and Continental Integration. Routledge. https://doi.org/10.4324/9780429057014Chapter

Google Scholar

Boochani, B. (2018). No Friend but the Mountains: Writing from Manus Prison. Picador Australia.

Google Scholar

Chung, R. (2021). Structural Health Vulnerability: Health Inequalities, Structural and Epistemic Injustice. Journal of Social Philosophy, 52(2), 201–216. https://doi.org/10.1111/josp.12393Article

Google Scholar

Dale, J. (2015). The Commonwealth’s Duty of Care to Asylum Seekers in Immigration Detention. Precedent, 128, 42–27.

Google Scholar

Das, V. (2006). Life and Words. University of California Press. https://doi.org/10.1525/9780520939530Das, V. (2015). What Does Ordinary Ethics Look Like? In M. Lambek, V. Das, D. Fassin, & W. Keane (Eds.), Four Lectures on Ethics: Anthropological Perspectives (pp. 53–125). Hau Books.

Google Scholar

De Graeve, K., & Bex, C. (2017). Caringscapes and Belonging: An Intersectional Analysis of Care Relationships of Unaccompanied Minors in Belgium. Children’s Geographies, 15(1), 80–92. https://doi.org/10.1080/14733285.2016.1254727Article

Google Scholar

Ellis, C. (2007). Telling Secrets, Revealing Lives. Qualitative Inquiry, 13(1), 3–29. https://doi.org/10.1177/1077800406294947Article

Google Scholar

Engster, D. (2007). The Heart of Justice: Care Ethics and Political Theory. Oxford University Press.Book

Google Scholar

Essex, R. (2017). A Community Standard: Equivalency of Healthcare in Australian Immigration Detention. Journal of Immigrant and Minority Health, 19(4), 974–981. https://doi.org/10.1007/s10903-016-0438-7Article

Google Scholar

European Commission. (n.d.). Reception Conditions. Retrieved December 8, 2021, from https://ec.europa.eu/home-affairs/policies/migration-and-asylum/common-european-asylum-system/reception-conditions_enFisher, B., & Tronto, J.C. (1990). Toward a Feminist Theory of Caring. In E. Abel & M. Nelson (Eds.), Circles of Care (pp. 36–54). SUNY Press.

Google Scholar

Gilligan, C. (1982). In a Different Voice: Psychological Theory and Women’s Development. Harvard University Press.

Google Scholar

Harding, R. (2018). Jurisprudential Sources for Establishing Standards of the Duty of Care in Offshore Immigration Detention Facilities. University of Western Australia Law Review, 43(124–142). https://doi.org/10.3316/ielapa.483891021610916Kouki, H. (2020). Introducing Care Ethics into Humanitarianism Comment on “A Crisis of Humanitarianism: Refugees at the Gates of Europe”. International Journal of Health Policy and Management. https://doi.org/10.15171/ijhpm.2020.14Laugier, S. (2015). The Ethics of Care as a Politics of the Ordinary. New Literary History, 46(2), 217–240. https://doi.org/10.1353/nlh.2015.0016Article

Google Scholar

Lépinard, É. (2020). Feminist Trouble. In Feminist Trouble. Oxford University Press. https://doi.org/10.1093/oso/9780190077150.001.0001Chapter

Google Scholar

Lisi, G., & Eliantonio, M. (2019). The Gaps in Judicial Accountability of EASO in the Processing of Asylum Requests in Hotspots. European Papers, 4(2), 589–601. https://doi.org/10.15166/2499-8249/314Article

Google Scholar

Morgan, M. (2020). Care Ethics and the Refugee Crisis. Routledge. https://doi.org/10.4324/9781003005223Book

Google Scholar

Namer, Y., Coşkan, C., & Razum, O. (2020). Discrimination as a Health Systems Response to Forced Migration. In K. Bozorgmehr, B. Roberts, O. Razum, & L. Biddle (Eds.), Health Policy and Systems Responses to Forced Migration (pp. 195–211). Springer. https://doi.org/10.1007/978-3-030-33812-1_11Chapter

Google Scholar

Okman Fişek, G. (2010). Relationality, Intersubjectivity, and Culture: Experiences in a Therapeutic Discourse of Virtual Kinship. Studies in Gender and Sexuality, 11(2), 47–59. https://doi.org/10.1080/15240651003666292Article

Google Scholar

Penning, V., Namer, Y., & Razum, O. (2021). Vulnerabilisation of Refugees: Covid-19—Related Experiences from Accommodation Centres in Germany. In N. Fromm, A. Jünemann, & H. Safouane (Eds.), Power in Vulnerability a Multi-Dimensional Review of Migrants’ Vulnerabilities (pp. 157–173). Springer. https://doi.org/10.1007/978-3-658-34052-0_8Chapter

Google Scholar

Rawls, J. (2001). Justice as Fairness: A Restatement. Belknap Press.

Google Scholar

Robinson, F. (2013). Global Care Ethics: Beyond Distribution, Beyond Justice. Journal of Global Ethics, 9(2), 131–143. https://doi.org/10.1080/17449626.2013.818466Article

Google Scholar

Ruddick, S. (1980). Maternal Thinking. Feminist Studies, 6(2), 342. https://doi.org/10.2307/3177749Article

Google Scholar

Schmid, S. (2019). Taking Care of the Other: Visions of a Caring Integration in Female Refugee Support Work. Social Inclusion, 7(2), 118–127. https://doi.org/10.17645/si.v7i2.1964Article

Google Scholar

Sevenhuijsen, S. (1998). Citizenship and the Ethics of Care: Feminist Considerations on Justice, Morality and Politics. Routledge.

Google Scholar

Sevenhuijsen, S. (2000). Caring in the Third Way: The Relation Between Obligation, Responsibility and Care in Third Way Discourse. Critical Social Policy, 20(1), 5–37. https://doi.org/10.1177/026101830002000102Article

Google Scholar

Sphere. (2018). The Core Humanitarian Standard on Quality and Accountability.

Google Scholar

The European Asylum Support Office. (2016). EASO Guidance on Reception Conditions: Operational Standards and Indicators.

Google Scholar

Tronto, J.C. (2012). Partiality Based on Relational Responsibilities: Another Approach to Global Ethics. Ethics and Social Welfare, 6(3), 303–316. https://doi.org/10.1080/17496535.2012.704058Article

Google Scholar

Tronto, J.C. (2013). Caring Democracy: Markets, Equality, and Justice. NYU Press.

Google Scholar

Tronto, J.C. (2017). There Is an Alternative: Homines Curans and the Limits of Neoliberalism. International Journal of Care and Caring, 1(1), 27–43. https://doi.org/10.1332/239788217X14866281687583Article

Google Scholar

Tsourdi, E. (2020). Holding the European Asylum Support Office Accountable for Its Role in Asylum Decision-Making: Mission Impossible? German Law Journal, 21(3), 506–531. https://doi.org/10.1017/glj.2020.21Article

Google Scholar

United Nations. (1951). Convention on the Status of Refugees.

Google Scholar

United Nations. (1966). International Covenant on Civil and Political Rights.

Google Scholar

United Nations. (1984). Convention Against Torture and Other Cruel, Inhuman or Degrading Treatment or Punishment.

Google Scholar

Urbina, I. (2021, December). The Secretive Prisons That Keep Migrants Out of Europe. The New Yorker. Retrieved on December 8, 2021 from https://www.newyorker.com/magazine/2021/12/06/the-secretive-libyan-prisons-that-keep-migrants-out-of-europeVosman, F. (2020). The Disenchantment of Care Ethics. A Critical Cartography. In F. Vosman, A. Baart, & J. Hoffman (Eds.), The Ethics of Care: The State of the Art (pp. 17–63). Peeters.Chapter

Google Scholar

Wong, B. (2019). On Relational Injustice: Could Colonialism Have Been Wrong Even If It Had Introduced More Benefits Than Harms? Journal of Practical Ethics, 7(Supplementary), 1–12.

Google Scholar

Download references AcknowledgmentsI thank Canan Coşkan who introduced me to the political conceptualizations of ethics of care and to Joan Tronto’s body of work. I also acknowledge that preliminary work on relational justice was co-created with Diana Podar and Florian Drüke. Author informationAuthors and AffiliationsDepartment of Epidemiology and International Public Health, School of Public Health, Bielefeld University, Bielefeld, GermanyYudit NamerAuthorsYudit NamerView author publicationsYou can also search for this author in

PubMed Google ScholarCorresponding authorCorrespondence to

Yudit Namer . Editor informationEditors and AffiliationsDepartment of Epidemiology and International Public Health School of Public Health, Bielefeld University, Bielefeld, GermanyOliver Razum Sydney Health Ethics Faculty of Medicine and Health School of Public Health, The University of Sydney, Sydney, AustraliaAngus Dawson College of Humanities and Social Sciences Department of Philosophy, George Mason University, Fairfax, VA, USALisa Eckenwiler Ethics of Medicine Faculty of Medicine, University of Augsburg, Augsburg, GermanyVerina Wild Rights and permissionsReprints and permissions Copyright information© 2022 The Author(s), under exclusive license to Springer Nature Switzerland AG About this chapterCite this chapterNamer, Y. (2022). Feminist Ethics of Care, Responsibility, and Refugee Accommodation: Concrete Steps Toward Improvements.

In: Razum, O., Dawson, A., Eckenwiler, L., Wild, V. (eds) Refugee Camps in Europe and Australia. Palgrave Macmillan, Cham. https://doi.org/10.1007/978-3-031-12877-6_8Download citation.RIS.ENW.BIBDOI: https://doi.org/10.1007/978-3-031-12877-6_8Published: 09 October 2022

Publisher Name: Palgrave Macmillan, Cham

Print ISBN: 978-3-031-12876-9

Online ISBN: 978-3-031-12877-6eBook Packages: Social SciencesSocial Sciences (R0)Share this chapterAnyone you share the following link with will be able to read this content:Get shareable linkSorry, a shareable link is not currently available for this article.Copy to clipboard

Provided by the Springer Nature SharedIt content-sharing initiative

Publish with usPolicies and ethics

Access via your institution

Buying options

Chapter

EUR 29.95

Price includes VAT (Philippines)

Available as PDF

Read on any device

Instant download

Own it forever

Buy Chapter

eBook

EUR 32.09

Price includes VAT (Philippines)

Available as EPUB and PDF

Read on any device

Instant download

Own it forever

Buy eBook

Hardcover Book

EUR 39.99

Price excludes VAT (Philippines)

Durable hardcover edition

Dispatched in 3 to 5 business days

Free shipping worldwide - see info

Buy Hardcover Book

Tax calculation will be finalised at checkout

Purchases are for personal use onlyLearn about institutional subscriptions

Search by keyword or author

Navigation

Find a journal

Publish with us

Track your research

Discover content

Journals A-Z

Books A-Z

Publish with us

Publish your research

Open access publishing

Products and services

Our products

Librarians

Societies

Partners and advertisers

Our imprints

Springer

Nature Portfolio

BMC

Palgrave Macmillan

Apress

Your privacy choices/Manage cookies

Your US state privacy rights

Accessibility statement

Terms and conditions

Help and support

49.157.13.121

Not affiliated

Religious Accommodation in Bioethics and the Practice of Medicine - PMC

An official website of the United States government

Here's how you know

The .gov means it’s official.

Federal government websites often end in .gov or .mil. Before

sharing sensitive information, make sure you’re on a federal

government site.

The site is secure.

The https:// ensures that you are connecting to the

official website and that any information you provide is encrypted

and transmitted securely.

Show account info

Account

Logged in as:

username

Dashboard

Publications

Account settings

Log out

Access keys

NCBI Homepage

MyNCBI Homepage

Main Content

Main Navigation

Search PMC Full-Text Archive

Search in PMC

Advanced Search

User Guide

Journal List

J Med Philos

PMC8022927

Other Formats

PDF (229K)

Actions

Cite

Collections

Add to Collections

Create a new collection

Add to an existing collection

Name your collection:

Name must be less than characters

Choose a collection:

Unable to load your collection due to an error

Please try again

Add

Cancel

Permalink

Copy

RESOURCES

Similar articles

Cited by other articles

Links to NCBI Databases

Journal List

J Med Philos

PMC8022927

As a library, NLM provides access to scientific literature. Inclusion in an NLM database does not imply endorsement of, or agreement with,

the contents by NLM or the National Institutes of Health.

Learn more:

PMC Disclaimer

PMC Copyright Notice

J Med Philos. 2021 Apr; 46(2): 188–218. Published online 2021 Apr 2. doi: 10.1093/jmp/jhaa038PMCID: PMC8022927PMID: 33822131Religious Accommodation in Bioethics and the Practice of MedicineWilliam R Smith1 and Robert Audi2William R Smith1

University of Pennsylvania, Philadelphia, Pennsylvania, USAFind articles by William R SmithRobert Audi2

University of Notre Dame, South Bend, Indiana, USAFind articles by Robert AudiAuthor information Copyright and License information PMC Disclaimer1

University of Pennsylvania, Philadelphia, Pennsylvania, USA2

University of Notre Dame, South Bend, Indiana, USAAddress correspondence to: William R. Smith, PhD, Department of Psychiatry, Perelman School of Medicine, University of Pennsylvania, 3535 Market St., Suite 200, Philadelphia, PA 19104, USA. E-mail: ude.nnepu.enicidemnnep@htimS.mailliWCopyright © The Author(s) 2021. Published by Oxford University Press, on behalf of the Journal of Medicine and Philosophy Inc. All rights reserved. For permissions, please e-mail: journals.permissions@oup.comThis article is published and distributed under the terms of the Oxford University Press, Standard Journals Publication Model (https://academic.oup.com/journals/pages/open_access/funder_policies/chorus/standard_publication_model)AbstractDebates about the ethics of health care and medical research in contemporary pluralistic democracies often arise partly from competing religious and secular values. Such disagreements raise challenges of balancing claims of religious liberty with claims to equal treatment in health care. This paper proposes several mid-level principles to help in framing sound policies for resolving such disputes. We develop and illustrate these principles, exploring their application to conscientious objection by religious providers and religious institutions, accommodation of religious priorities in biomedical research, and treatment of patients’ religious views in doctor–patient encounters. Given that no sound set of guiding principles yields precise solutions for every policy dispute, we explore how morally sound democracies might deliberatively resolve such policy issues, following our proposed principles. Taken together and carefully interpreted, these principles may help in guiding difficult decision making in the indefinitely large realm where government, medical providers, and patients encounter problems concerning religion and medicine.Keywords: conscience, mid-level principle, normative principles, professional obligations, religious accommodation, special obligationsI. INTRODUCTIONContemporary societies—especially pluralistic democracies, such as that of the United States—have grown increasingly secular. Simultaneously, their citizens have often asserted stronger claims for religious accommodation, and legislators have often advocated policy on (seemingly) religious grounds. This tension raises the question of what norms are relevant to governing such societies, with religious and nonreligious citizens who should be free and equal before the law. This question is particularly pressing because, in pluralistic, democratic societies, citizens must govern each other through democratic mechanisms and must cooperate through nongovernmental institutions and practices that further realize and sustain their status as equals in society. Such concerns are especially important for biomedical ethics, where many challenges, including those involving determination of the beginning and end of human life, have controversial religious implications.The societies with which we are concerned have three specific features: they are democratic, pluralistic, and liberal.1 In turn, they tend to emphasize values corresponding to each: those of democratic government, mutual respect between individuals with differing worldviews, and protection of rights and freedom. Yet, conflicts can arise between these values. For example, certain exercises of autonomy and religious liberty may yield or perpetuate harms and inequalities. Various traditions have emerged that address such conflicts (including those of Millian liberalism, justificatory liberalism, and deliberative democracy), and often these traditions have attempted to negotiate these conflicts with principles through which one value governs the others (e.g., emphasizing precedence of liberty, democracy, or respect for pluralism). In contrast to such monistic traditions, here we develop a pluralistic framework. Our principles provide general guidance for conduct of providers and institutions. Several of our principles have been described elsewhere (Audi, 2000, 2011b). Here, we extend them to address accommodation of religion biomedical ethics, adding further principles to cover this domain.Drawing on the recent revival of intuitionism,2 we take our principles to be justified intuitively, by a kind of reflection—even if they are not quite self-evident. Furthermore, we take them to be mid-level in the sense that they are also derivable from more basic principles; hence, further justification can be garnered from sources other than intuition, such as those of ethical theory.3 Indeed, we believe that these principles can be so derived from various more fundamental principles, including those featured in the traditions mentioned above, such that our framework may be attractive to theorists from a diversity of perspectives. We take this to be a key virtue in pluralistic societies.Because our principles—in keeping with many elements of the intuitionist tradition—are only prima facie, they generally do not entail the illustrative applied claims that we discuss. In contrast, while we think deductive arguments as well as intuitive judgments can be offered for many of our applied views, we devote much of this text to drawing important distinctions4 between related views. Additionally, we supplement the basic framework with further theoretical resources that support our applied views when taken together with our prima facie principles. The point of our illustrations is, mostly, to support an inference to the best explanation for our framework. We aim to show that, when supplemented with other plausible claims, our view has broad explanatory power and thus significant support.5We proceed as follows: Section I reviews critical background issues about the epistemology and methodology of our intuitionism. Section II introduces the basic elements of our framework. Sections III–VI illustrate its applications to questions of accommodation in bioethics. Obviously, we cannot cover all of the relevant issues, but we focus on issues of conscientious objection by individuals (Section III) and institutions (Section IV), as well as questions of accommodation in research (Section V) and accommodations for religious patients both by their providers and by their proxy decision-makers (Section VI). We focus on these topics in part because they emphasize a wide range of topics that a theory of religious accommodation in such societies must help explain, thus supporting the inference to our framework as the best explanation of this domain.Before proceeding, we should first clarify the three key features of the societies on which we focus: democracy, pluralism, and liberty. First, we take a democratic society to be (roughly) one that citizens collectively control, primarily through institutions and procedures in which they equally have a voice. Different conceptions of such equality suggest different conceptions of democracy. Some minimal standards are widely accepted, including at least two: (1) formal equality in voting mechanisms (as enshrined in, e.g., the one-person, one-vote rule) and (2) formal equality before the law, which prohibits preferential legal treatment of particular individuals or groups. On some conceptions of equality, democracy may further require providing certain resources, opportunities, or capabilities—the kind whose absence might undermine political power or equality in status.6Second, the societies that concern us are pervasively pluralistic: they feature substantive, often recalcitrant disagreements among their citizens about fundamental norms of government.7 If there were agreement on basic questions of, for example, distribution of resources, human rights, and political processes for decision making, then perhaps the remaining disagreements could be surmounted procedurally with results acceptable to all. But pluralism, as known in many contemporary societies, such as the United States and the United Kingdom, is too deep and pervasive for dispute resolution to be easy. Citizens disagree about what values governments should promote, as well as about what human, political, and civil rights they ought to protect. In many cases, there will be some citizens that object to the results of whatever decision-making process is used in dealing with such disagreements. Our proposed framework is intended to help in resolving these disagreements.Third, the societies that concern us are liberal in the sense that they make special provisions to protect civil and political rights, particularly liberty rights such as free expression. A broad form of liberalism is a fitting response to pluralism in these societies for at least two reasons. First, it is fitting for pluralistic societies because, in the face of the aforementioned disagreements, powerful factions will often be tempted to prohibit actions of which they disapprove. The assiduous protection of liberty—a hallmark of liberal democracy—counteracts such temptations. Second, the liberal response is fitting for democratic societies because equal protection of basic rights is a constitutive means of realizing equality before the law.II. INTUITIONISM8We take the principles of our framework to have prima facie epistemic justification as intuitions. Before outlining the principles themselves, we should comment on the nature of this justification and the strengths we think it offers. We then further defend this view of justification against concerns. In particular, some might think intuitionism a problematically naive picture of epistemic inquiry because such appeals depend on an implausible appeal to a “view from nowhere,” or because appeals intuitions serve as “conversation stoppers,” or because antitheoretic appeals to intuitions cannot accommodate the productive role of moral theory.In bioethical discourse, the first objection may be particularly pronounced. Several have asserted that “there is no view from nowhere.”9 Often, this objection explicitly draws on the tradition-based epistemological reflections of Alasdair MacIntyre (2007). Indeed, some, inspired by MacIntyre, appear to suggest that, “few serious thinkers today believe that” moral values can be defended in secular terms without tacit reliance on some normative tradition (perhaps meaning one covertly hostile to religion as such) (Camosy, 2012, 13–4).10 Yet, while we believe that traditions can offer important sources and inspiration for reflection, we also reject the idea that justification is intrinsically internal to a tradition.11Perhaps confusingly, the term “ethical intuitionism” refers to two distinct views. One of these is a view in moral epistemology, according to which an agent may be noninferentially and intuitively justified in accepting some propositions expressing practical (and/or moral) reasons—say the proposition that killing persons is (prima facie) wrong. The other view concerns normative ethical theory; it is a pluralism that posits a number of distinct, foundational principles, which are, according to it, intuitively justifiable. Notably, the discussion here does not assume that our principles are foundational. Furthermore, we rest our framework on intuitionist epistemology here, but others could adopt our normative view without endorsing our metaethics.On our epistemic view, certain propositions can be noninferentially apprehended in such a way that an agent’s comprehendingly and reflectively considering them provides some justification for believing them; we call these intuitions.12 Some of these are self-evidential—roughly, they are true and agents may be justified in holding them in virtue of adequately understanding them and may know them by believing them on that particular basis. A proposition’s being intuitive in the general way just described, or even further, being self-evident, does not entail that it is obvious or widely known.13Defending propositions as intuitive need not rest on simple assertion nor need it be dogmatic. General principles can be suggested by way of illustrative examples—particularly when those examples can be multiplied or generalized. Instead, one way, among others, that defense can work is through enhancing and refining the understanding of the proposition in question. Similarly, responding to purported counterexamples can be a means of defending an intuitive proposition. For example, one might show how the purported counterexample can be accommodated (e.g., by showing it falls outside the scope of the proposition) or offer an error theory to explain away its appeal. All of these can be methods of defending propositions as intuitive (or even self-evident), but none work by appeal to premises in a deductive argument that replaces the intuitive defense for the proposition in question.14There is a further way in which defense of intuitive propositions need not rest on simple assertion or dogmatism. Though agents may have non-inferential justification in believing intuitive propositions, this does not imply that intuitive propositions generally, nor self-evident propositions more specifically, cannot be argued for via deductive argument. Belief to the contrary may have historical precedence, because many early intuitionists, such as Ross (1930/2002, Ch. 2), took self-evidence to entail unprovability. Yet, this view is mistaken; for one thing, various theorems of standard logic or mathematics may be self-evident but also provable from other premises. So, too, with some moral intuitions. Here, as elsewhere, it is critical not to neglect the possibility of justificatory overdetermination. In argument, the advocate of some proposition as intuitive or self-evident may be able to find premises to support the proposition, even if the opponent refuses to admit its intuitive or self-evidential status. Indeed, religious persons might take there to be intuitive support for such reasons—though that is, of course, not the only justificatory support that they might take such reasons to have.Of course, none of the above implies that there will not be exchanges in which arguments reach an impasse—for example, because of disagreements about cases, examples, premises, or other matters. Yet, the discussion above suggests that there is nothing distinctive of appeal to intuitive propositions that should make them particularly susceptible to this. This is critical because, in light of gaining justification without having to derive it from premises in deductive arguments to support them, appeals to intuitive propositions can stop the threat of justificatory regress that nonfoundationalist moral epistemologies must face.In light of the above, we can respond to the three concerns about intuitionism introduced at the beginning of this section. First, appeals to intuitionism need not depend on any “view from nowhere” in the sense of being tradition free. Consider how, on the intuitionist view, understanding may genetically depend on experience for development without justificationally depending on experience (Audi, 2018, 2n4). One may, for instance, need to draw on various resources in considering the concept of harm and its application to particular circumstances. Yet, while one’s understanding of a proposition about harm may genetically depend on such experience, one may have noninferential justification in believing that proposition through deploying this understanding in an intuition. This may be the case either about a general proposition (such as that it is prima facie wrong to cause harm) or about a particular example (such as that this particular harming is all things considered wrong). Similar genetic dependence may stem from tradition or testimony—if, for instance, one’s understanding of harm draws on a tradition. This does not prevent a particular claim about the wrongness of causing harm relative to that of preventing a particular rights violation from knowability by the relevant intuition(s).Of course, complaints that there is no “view from nowhere” are not always related to views about traditions.15 Sometimes complainants suggest their opponents’ views depend on some implausible form of objectivity, neutrality, or authority. Intuitionism rests on no such implausible claims. Of course, one’s intuitions are one’s own, but that need not deprive them of fairness, objectivity, or justification. Moreover, an appeal to intuition is not an authoritarian claim that in itself should convince one’s interlocutors of one’s view, but that need not undermine one’s justification.16Second, appeals to intuitions need not be “conversation stoppers.” Appeal to intuition does not preclude offering further arguments to interlocutors. Demands for further explications, illustrations, examples, and responses to purported counterexamples can be made and may be met. Indeed, meeting such demands exemplifies the understanding necessary for one’s intuitions to serve as justificatory.Finally, intuitionists need not be antitheoretic. Because a proposition’s status as intuitive or even self-evident does not entail that it cannot be derived from premises, intuitive and self-evident propositions can be incorporated into an ethical theory, especially where they can be demonstrated from more basic parts of the theory. Indeed, the sorts of abductive arguments for various ethical theories over their opponents, such as those of inference to the best explanation, rest on taking some datum—like an intuition about a moral claim in some case—and showing the theory to explain it. Furthermore, the intuitionist has a ready explanation of how explaining the datum provides justificatory support for the theory: the datum is itself justified and so inference from it can provide justification. Those who deny that intuitions provide justification need to explain this phenomenon.17III. THE CORE FRAMEWORKWe now turn to detailing the core principles of our framework—although supplemental principles will be added as we extend it to various topics in biomedical ethics. We start with several prima facie principles that are called for concerning governmental treatment of religion and citizens—both religious and nonreligious. First are two concerning equality across religious and nonreligious persons:

The neutrality principle: Government should accord equal treatment to the nonreligious and the religious.

The equality principle: Government should accord equal treatment to different religions within its jurisdiction.The neutrality and equality principles seem intuitive and cohere well with the Establishment Clause of the First Amendment of the U.S. Constitution.18Further principles are necessary regarding protection of liberty and equality. First is

The liberty principle: Government should protect religious liberty to the highest degree possible within a reasonable interpretation of the harm principle—i.e. (in rough terms), the principle that restrictions of liberty are justifiable only on adequate evidence that they are required to prevent significant harm.Interpretation of the liberty principle depends on that of the harm principle, which is discussed in detail by J. S. Mill (1859/1978, 9–10), who first offered it (in a slightly different formulation), and by a multitude of later writers.19 Philosophers, jurists, and others have generally understood harm as (some type of) setback to interests, prominently including physical injury. Disagreement emerges on what other actions constitute harms. Furthermore, there is debate on which beings’ harms are relevant, on which types of harms are relevant, and on how various degrees of harm bear on justification for limiting liberty. We suggest that this scope include not only persons, but also other biological species and, potentially, the environment, but a full account of how these different contributions are to be weighed is beyond the scope of this essay.Even granting these suggestions, further debates remain about the harm principle. Perhaps cases of harmless trespass, harmless contract violation, or other harmless infringements illustrate that governmental coercion is justified to prevent harmless wrongdoing (since it is clearly reasonable to illegalize many such wrongs) (Hart, 1982; Kamm, 2007; Ripstein, 2006). If so, the harm principle may need supplementation.20In particular, one might argue that government must not only prevent harm, but also promote the realization, protection, and promotion of each citizen’s status as an equal before the law.21 This normative standard is implicit in the democratic commitment to a kind of basic political equality, since that is threatened directly by inequality before the law and, in some cases, by major disparities in socioeconomic power. As an intuitively powerful way of capturing this demand, we propose

The social equality principle: Government should protect and, in some cases, promote equal sociopolitical relations among citizens, at least insofar as promotion is needed to assure equal status before the law.22To illustrate briefly, the social equality principle might require, among other things, significant legal changes to limit the influence that private money is allowed to have in governmental elections because citizens might take the law to treat them as unequally if moneyed interests have a certain kind of disproportionate power in determining representation and policy. It might also require stronger mechanisms to ensure public defense—as the law arguably does not treat one equal insofar as one’s lack of wealth raises the risks of losing at trial.23Our framework does not completely determine the application of all its principles to all relevant cases. Leaving many cases open, even with appropriate reflection and further intuitively plausible principles that we detail as we proceed, our framework requires deliberative principles to aid in decision making for democracies. In keeping with a broad family of liberal positions on this topic, we propose one such principle,

The principle of secular rationale: Citizens in a democracy have a prima facie obligation not to advocate or support any law or public policy that restricts human conduct, unless they have, and are willing to offer, adequate secular reason for this advocacy or support (e.g., for a vote).24For illustration, religious individuals might fulfill this duty in indicating that they oppose capital punishment mainly for religious reasons but further arguing that their basis for proposing its legal elimination is its tendency to be unequally imposed, mistakenly administered or a burden on courts that affects the overall administration of justice.The principle of secular rationale is a principle of restraint, resembling, but often more permissive than, those which many others (particularly justificatory liberals and deliberative democrats) advocate.25 The particular restraint described by the principle of secular rationale is a duty of citizens in the contexts of advocacy for or support of coercive laws or public policies. This restraint is not directed toward discourse as such, does not restrict freedom of speech, and does not license coercive restriction by government or others on such free speech. Furthermore, it may guide citizens in displaying mutual respect and tolerance.26 When obligations are vague and reasonable citizens disagree, the ethics of citizenship demands that we exhibit tolerance to alternative interpretations of such obligations, especially in charged political environments where the risk of disrespect to those with whom we disagree is high.27 Likewise, in seeing that our view matters to our opponents, we can more readily feel respected. By offering secular reasons for their views, those who advance religiously supported positions can exhibit respect to others in acknowledging that others’ points of view matter.The meaning of the term “secular” is critical.28 For a reason to be secular is roughly for it to be evidentially free of dependence on the authority of God’s pronouncements, religious institutions, and commitment to God (Audi, 2011a, 67). Importantly, evidential independence from beliefs about God’s existence does not imply that such reasons are independent of God’s existence. Such evidential independence also allows access to these reasons for individuals who disagree about the role of religious claims in the metaphysics of reasons; it does not even entail that there cannot be theologically sufficient grounds for normative propositions. Hence, the secular is not anti-religious, in that it allows that religious believers take the reasons to be metaphysically grounded in various theological theses—so long as they can be evidentially based on nontheological premises. Here the point mentioned above, in discussion of intuitionism, about justificatory overdetermination is also relevant. The principle of secular rationale merely requires that the reasons invoked be justifiable without such religious evidence. Of course, religious persons will often take God or religious institutions to prescribe concern for others, stewardship of environmental resources, and the like; such individuals can take these reasons as secular so long as they take there to be justification for such reasons that does not depend on a religious basis—even if religious support also gives justification.29Several further clarifications are important regarding the limits of this principle.30 First, this principle allows for religious reasons to be offered in public deliberation.31 Returning to our illustration above, if the religious citizen has satisfied the prima facie obligation to have and be willing to offer adequate secular reason for eliminating the death penalty, she might further also invoke various religious claims in arguing for its elimination, such as that all individuals have a kind of sacredness as ensouled by God. The fact that the principle of secular rationale allows introduction of religious reasons is important, especially given that there are powerful arguments that religious institutions avowing religious reasons can offer inroads to political participation for the disenfranchised and that previous cases, such as those of Dorothy Day, Martin Luther King, Jr., and Desmond Tutu, have taught us that religious reasons can spark powerful arguments for advancing the ends of justice.32Thus, just as the principle is not antireligious in its appeal to secular reasons, so too, it is also not antireligious, in that it permits appeal to further reasons that do depend on religious beliefs or institutions as evidence. Instead of seeking to eliminate the use of religious reasons in public deliberation, the principle is designed to accommodate both religious and secular citizens by asking them, in effect, to take considerations they can share simply as rational and adequately informed persons as common ground providing a prima facie necessary condition for justifying coercive laws or public policies.Second, like the other principles we propose here, it expresses a prima facie—hence defeasible—obligation. To see how defeat can occur, imagine a dictator so effectively brainwashing much of a population that a majority could support patently unjust laws. Suppose religious citizens might effectively oppose instituting those laws only by enlisting all the power of their religious position and its traditional influence in the population. This is not to say there would not be adequate secular reasons for opposing the proposed legislation; the point is that if only religious arguments would block the legislation and protect the population from serious harm, the prima facie obligation under the principle of secular rationale might be overridden.33Finally, the role of the principle of secular rationale in the broader intuitionist framework we defend is importantly distinct from that in justificatory liberal frameworks and many deliberative democratic views. Broadly speaking, deliberative democrats claim that “citizens and their representatives . . . are expected to justify the laws they would impose on one another” to each other through public deliberation (Gutmann and Thompson, 2004, 3).34 Similarly, justificatory liberals have claimed that a law (or policy) is justified only if all reasonable constituents35 have sufficient reasons to endorse it,36 where the concept of justification in play is often that of legitimacy.37 Both are often heavily influenced by John Rawls,38 and both frequently adopt some requirement like his duty of civility (2005, 444)—a principle of restraint somewhat similar to the principle of secular rationale. As we understand it, it requires citizens to appeal to public reasons “when debating fundamental political questions,” allowing that they might “introduce . . . at any time [non-public reasons], religious or nonreligious, provided that in due course” (Rawls, 2005, 453), they provide “properly public reasons” to support their claims (Rawls, 2005, 462).39With many deliberative democrats, we agree that public deliberation can guide in setting acceptable rules for shared, democratic governance when basic frameworks—such as constitutional essentials and matters of basic justice40—are not fully determinate. In particular, we note that ethically conducted citizenship can, through deliberation, specify whether a policy of accommodation reasonably balances the protection of liberty with that of equality in cases where reasonable people differ in their assessments. However, unlike many deliberative democrats, we would deny that such deliberation (even as a matter of regulative ideal) should be free from prior norms.41 In addition, we reject the justificatory liberal claim that justified law or policy must be such that each citizen has sufficient reasons to endorse it. On our view, the relationship between respect and the principle of secular rationale is not mediated by this principle, but is direct and intuitive (although not self-evident). We take the intuitive support for this relationship to be stronger than many competing views in light of the fact that the principle of secular rationale is limited in several of the ways we have mentioned.42IV. ACCOMMODATION OF RELIGIOUS PRACTITIONERS: THE CASE OF CONSCIENTIOUS OBJECTIONWe now turn to applications of our framework to particular issues in biomedical ethics, noting that we need to add supplementary principles as we proceed.43 We begin with the question of conscientious objection by individual providers. Given that some exercises of religious liberty by medical providers may cause harm or produce unequal treatment, the foregoing principles bear on conscientious objection. In particular, they support a moderate position, similar to those advocated by others,44 on which providers may refuse to give services if and only if their objection to doing so is (1) nondiscriminatory, (2) does not violate their professional obligations or socially just laws, (3) does not excessively burden the patients seeking service, and (4) is accompanied by ensuring that patients know how to access the refused service(s), for example, by referral.To see why the rights of conscientious objection are limited, first note that the liberty principle and the social equality principle45 favor fulfilling medical needs as protections against harm and threats to equality. Hence, there are particularly forceful considerations for governmental action that weigh against those to protect religious liberty.46 In turn, governments often have reason to coerce those who object to providing services in emergencies or would refrain from informing and referring patients for (legal and just) care they refuse to provide. This supports the view that government ought to protect medical needs—even at certain costs to religious liberty. When conjoined with a picture of professional obligations that we describe below, it supports, more specifically, limits on conscientious objection.47The professional duties that providers have to patients are, unfortunately, both vague in content and plural in nature. There is no simple account of such duties, and the general claim that physicians must prioritize patients’ interests is shot through with exceptions (Wendler, 2010). Strict opponents of conscientious objection who claim that providers must give any service that is legal, distributively just, requested by the patient, and/or at the core of the medical practice48 face such difficulties as requiring providers to offer services outside their specialty. If, however, one limits the services required by including only those in the practitioner’s specialty,49 one encounters the difficulty that providers often (reasonably) subspecialize or focus their practices in some other way. For example, those certified in obstetrics and gynecology might choose to pursue either gynecological surgery or obstetrics, rather than offer the full range of legal gynecological services.In contrast, we suggest that medical professionals’ duties are determined in part50 by their role as agents of, or at least bearing some moral responsibility to, societies through governmental and other institutions that reinforce or impose duties to protect healthcare rights and equal treatment under laws and public policies.51 Given the relationship between medical need and the liberty and social equality principles noted above, as well as society’s obligations to promote opportunities of their constituents (for which health is needed) and to protect their constituents’ basic human rights (of which some degree of health care is one), society has reasons to place certain requirements on individuals well-suited to discharge institutional obligations, including obligations to fulfill medical needs. Given that society has such reasons and that medical providers are well-suited to discharge them, medical providers acquire obligations to their patients and regarding the public health from society.52 In addition to their obligations to their patients, providers have duties to each other to ensure fair distribution of these responsibilities among one another. Given this obligation of fair distribution, and given that many cases of conscientious objection are foreseeable, those who conscientiously object have duties to anticipate situations in which they will be morally obligated to refer patients to colleagues—as do the institutions of which they are part.There will often be significant disagreement about providers’ special obligations to their patients—in part because of their vagueness, the role of various institutions in their specification, and the reasonable disagreement characteristic of pluralistic societies. Often, and certainly in some important cases, disagreements arise from different religious perspectives or differences between some religious and some secular moral convictions. Even the best normative theories will not directly imply a particular verdict for every case; however, adequate frameworks for democratic societies require principles of deliberation for settling specific cases. Here, we note a significant role for democratic deliberation employing the principle of secular rationale, as described above.V. ACCOMMODATION OF RELIGIOUS INSTITUTIONSIn addition to questions of individuals’ conscientious objections, there are questions of religious medical institutions’ conscientious objections—and, furthermore, more general questions of governmental accommodation of such institutions. Perhaps the most familiar of these are those of Christian organizations that refuse to provide services that they see as contraceptive, abortive, or abortifacient. For example, recent lawsuits concerning the Department of Health and Human Services’ (HHS) regulation that healthcare coverage under the Affordable Care Act must include contraceptive services have called attention to one sort of position on this issue—that of the Religious Freedom Restoration Act (RFRA) (U.S. Congress, 1993). Roughly, RFRA precludes the federal government’s “substantially burden[ing] a person’s exercise of religion” except in cases where such burden “furthers a compelling interest” through the “least restrictive means” of doing so. In Hobby Lobby (2014), the U.S. Supreme Court held that closely held corporations qualify as persons under this legislation. It argued that the HHS requirement violated RFRA in placing requirements on closely held, private corporations to provide coverage that owners find religiously objectionable when a less restrictive means was possible, which the government had provided to religious nonprofit organizations. It further rejected the possibility of legally drawing a distinction between the RFRA rights of religious non-profits and closely held, private corporations with religious owners.53These issues raise several questions regarding what standards of conduct are compatible with our framework. This section addresses three of them in a way that illustrates how the framework accommodates religious institutions. In so doing, we focus on the text of RFRA—rather than on legal issues about judicial precedent of substantial burdens and least restrictive means.54 First, how are corporate agents—and group entities more broadly—to be treated on this framework? Second, if there are grounds for protection of conscientious objection of institutions, is the Court correct in thinking that there is not a means of distinguishing between the values of religious institutions and those of closely held corporations that have religious ownership? Third, if there are such grounds, would not the RFRA standard, which appears to set a fairly strict burden on demonstrating minimal restriction, generally cohere with the liberty principle, which requires maximal protection of religious liberty as consistent with a reasonable interpretation of the harm principle?In the wake of Citizens United (2010), there is widespread skepticism about ascribing personhood to institutions and organizations. This invites skepticism regarding the Court’s general project of ascribing rights of conscientious objection to such agencies. It is important here to note that organizations might have some rights and duties of legal personhood while lacking others. It is further important to note that, for our purposes, even if one doubts whether corporations should have (all) legal rights of personhood, there is a distinct question of whether organizations display agency, and there are many plausible accounts on which they do (Tuomela, 2013; Shapiro, 2014). In particular, we believe that organizations may have capacity for “conscientious” objection55 in virtue of the fact that they can be committed to values, integral to their identity, just as individuals do.56Of course, the degree to which different types of institutions have values that are critical to their identity varies in several ways. Some religiously affiliated institutions might reasonably be taken to have religious values central to their institutional identities. This may not be true of closely held private institutions that merely happen to have religious owners.57 In particular, merely being an owner of a religious organization and having religious values does not entail that these values are integral to one’s corporation’s identity. This is in sharp contrast to the way in which values may be partially constitutive of churches or explicitly religious institutions, such as a Roman Catholic school.Furthermore, some such corporations make loose reference to religious values in their mission statements or practices—for instance, in being closed on Sundays or in having “Biblical values.” Yet, loose reference to religious values—even in statements or practices that might indicate that values loosely construed are integral to organization identity—will often be insufficiently clear to show that those values justify religiously grounded objection. In contrast to an organization that is owned by a religious institution that has explicitly pronounced an explicit value relevant to the objection at hand, where employees and others interacting with the organization might reasonably be expected to know the implications of the religious values in question for the objection, vaguely stated values do not convey such clarity. In such cases, their corporations lack grounds to claim that those values are central to their identity.If, as we hold, organizations can plausibly be considered agents and, as such, have central values that might make conscientious objection by an institution possible, the question arises of whether—and the degree to which—such objection should ground rights and privileges in a democratic, pluralistic society. In particular, if institutions are agents with such values, does not the liberty principle favor a rather robust conception of how such values are to be protected—one much like that of RFRA? The answer depends on what reasonable interpretations of the liberty and social equality principles require, and we do not believe they support such a robust conception. The following four points can clarify general contours of our interpretation in this context.First, keeping in mind our points about the source of providers’ duties, such institutional questions occur in the context of three-part relationships in which (1) a provider is acting as a member of (2) an institution in caring for (3) a patient. The institution has several responsibilities in addition to those dictated by its institutional values, including responsibilities to its employees, its patients, and certain government agencies. For example, often physicians treat patients within relationships defined not merely as those between doctors and patients, but further as one between an institutional employee and a patient.Second, if institutions are to have rights of objection, then, as noted for providers, though they have not forfeited their claims to conscientious objection, they nevertheless have duties to establish and sustain practices in which they can meet further duties to inform and refer.58 Generally, Catholic hospitals that refuse to offer abortions in non-emergency circumstances have prima facie obligations to arrange transfer mechanisms to partner hospitals in their communities. Moreover, fairness would suggest that such hospitals be willing to provide other services that benefit their community partners.Third, given that both providers and institutions have such duties—and are relying on each other in their fulfillment of them—they seem to have duties to each other, and thus also rights, to see these fulfilled. This partly explains why, in general, it is not necessarily invidious discrimination to refuse to hire—or indeed to fire—providers or pharmacists who would invoke mechanisms of conscientious objection, where creating and sustaining such mechanisms imposes significant costs on the institution, as it is likely to in many cases. For example, a 24-hour pharmacy might have only one pharmacist working overnight or a hospital may have only one obstetrician on call overnight. In both cases, the institutions might reasonably inquire about the moral views of those that they employ, or are considering employing, and refuse to employ those whose views would require them to hire additional staff in order to fulfill their duties to patients. Indeed, we take the principles so far proposed to support a defeasible requirement, like that proposed by others,59 on major medical institutions as well as governments to reserve a certain proportion of positions for competent providers who are willing to perform certain duties.For instance, consider the related case of a local community hospital that lacks a sufficient number of obstetricians (relative to patient demand) who are willing to perform elective abortions in a country where abortion is constitutionally protected. How might our position apply to a local public hospital in such a community? Our framework does not entail a particular detailed position in such a complicated case. Much might depend on the number of obstetricians from other hospitals or clinics willing to provide abortions, as well as the access that patients may have to providers in nearby communities and the distance they would need to travel to reach such providers. Yet, clearly our position suggests a prima facie obligation to serve the medical needs of patients within the scope of the law. In turn, a plausible view, in keeping with our framework here, as well as suggestions of others (Minerva, 2015, 2017), might be that such a hospital does no wrong in refusing to hire further obstetricians unwilling to provide abortions—or in paying higher wages to those who are willing. Indeed, all else being equal, in certain circumstances such a hospital might have a prima facie obligation to do so, if that would incentivize a sufficient number of providers to perform legal elective abortions in appropriate cases.60,61Fourth, institutions that receive government funding will also be in a triply special relationship with patients as (1) an agent of a pluralistic democracy that should provide access to needed medical interventions, (2) the institution caring for a patient, and (3) the institution discharging its employees’ responsibilities to inform and refer in cases of conscientious objection. This raises the demands on such institutions to achieve equal treatment of patients irrespective of religious convictions.In light of these points, we believe that reasonable interpretations of the harm principle and the social equality principle limit institutional liberty without implying that it does not deserve respect. In many cases, allowing referral for elective abortion rather than requiring performance is not a great imposition on patients and, in such cases, should be allowed in deference to some institutions’ deeply held values. In turn, the question arises of how to address this problem without imposing unfair burdens on other facilities. One reasonable solution might be to require these institutions to do more to preserve social equality in other ways.However, strict limits for institutional religious liberty arise in emergencies. Notably, severe cases of sepsis or hemorrhage have been documented when providers refused to induce labor in cases of miscarriage.62 In such circumstances, transfer to alternative facilities, in order for a conscientious objector to avoid performing what he or she perceives as an abortion, can be quite dangerous. When such occurs, then, as in the case of the moderate position we propose for individual objectors, invoking conscientious objection to require such transfer is impermissible.VI. ACCOMMODATION OF RELIGION IN BIOMEDICAL RESEARCHWe now turn to extending our framework to accommodation of religious individuals in research, including the questions of governmental prioritization of and researchers’ liberties in projects that may be seen as friendly or antithetical to different religions. Regarding governmental prioritization, the neutrality and equality principles suggest that equal treatment ought to be given to the religious and nonreligious alike and to members of different religions. The notion of equal treatment is complex. Equal treatment does not, for instance, imply the same treatment63 but must allow differential treatment—provided its basis is nonreligious, and it is otherwise justified.For instance, perhaps, having state holidays on Christian feast days is acceptable in nations with Christian majorities, but only if members of other religious and areligious groups are given comparable leave for their observances. Indeed, it may be that a further condition is needed to justify such ostensibly preferential holiday patterns—for example, that some compensatory benefits are afforded to minority religious groups. These might include government incentives, for instance, publicity that might be used to make their belief systems more widely appreciated. Such incentives might further benefit pluralistic, liberal democracies by helping citizens understand the similarities and differences among their beliefs.The requirement to treat religions equally in the research context raises the question of how to set research priorities among potential interventions for conditions where some of the potential interventions may be objectionable to some religions. These interventions might include those employing in vitro fertilization, bioprosthetic surgical materials (such as valves), and blood transfusions.64 While citizens without such objections have reason to accommodate those who object, resources devoted to such development could not be directed toward other research projects of benefit to all. Hence, accommodating particular religions may pose a loss to citizens with different beliefs.Among the considerations that affect determination of equal treatment is the relative stringency of different religious obligations for members of different religions. For example, various religions prohibit biological valves. However, on some standard religious teachings, Jewish patients and, in extreme circumstances, Muslims may receive porcine products, while the Hindu prohibition on bovine products is stricter.65 If scarcity or budgetary constraints impose prioritization decisions, the relative stringency of these teachings could create some reason to prioritize research on porcine products—or perhaps on further alternatives that do not face religious objection, such as equine products (at least when such products are fitting for the procedure involved). Yet, these reasons may be limited in part by other patients’ reasonable expectation that research with the most promise to promote health (nonreligiously construed) be prioritized. Perhaps, for different societies, the strength of reasons for religious prioritizations is relative to the proportions of the populations that follow the different, strict, religious standards. For instance, reasons to favor nonbovine valves may be weightier in India than in the United States.The strength of the reasons at stake will often be vague, making this a situation in which the ethics of citizenship plays an important role in shaping public and institutional deliberation about prioritization. In any case, the principle of secular rationale poses limits on what kinds of reasons are needed. Because it recognizes a duty of citizens to support equal treatment of fellow citizens with different beliefs, compliance with the duty to offer nonreligious reasons helps to ensure equal treatment of minorities in societies where (consciously or not) religious voting blocs may be tempted to prioritize their own interests in research funding.The principle of secular rationale may also aid in addressing related concerns about the effects of religious voting blocs on regulation of research conduct. Perhaps, Christians in the United States who endorse strict prohibitions on removing of artificial nutrition and hydration would advocate greater oversight on related research—such as that on organ procurement after brain death. Such a policy might violate the principle of neutrality, but setting that aside, to the extent that a duty to offer adequate secular reasons for coercive laws or public policies is acknowledged, those favoring such oversight will be disposed to see that they must do more than simply vote their political interests.VII. ACCOMMODATION OF RELIGIOUS PATIENTSFinally, we address accommodation regarding religious patients. Such accommodation must respect both providers (individual and institutional) and religious patients in a way that recognizes all individuals as equal before the law. To aid in this, we suggest that, insofar as medical professionals’ duties are grounded in governmental and institutional duties to protect equality and neutrality, they have some reason to respect similar principles like those of equality, neutrality, and liberty in the doctor–patient relationship.One plausible principle for professionals’ role is

The principle of practitioner religious neutrality: Medical professionals have a prima facie obligation to observe a distinction between their personal religious views and their views as professionals, to prevent any religious aims they may have from dominating their professional conduct, but also to allow patients’ religious views a role in the relationship to the degree that it contributes to their patients’ medical care.66Nondomination here does not preclude that providers’ religious worldviews have some influence in their interactions with patients—though there are complexities about this influence, some of which we will clarify. However, in keeping with our framework as presented thus far, we take nondomination to require that, at least, providers have adequate secular reasons for medical decisions that they make.In support of this principle, note first that neutral treatment of patients by medical practitioners is asymmetrical; for the most part, it is the duty of the professional to accommodate the patient and not that of the patient to accommodate the professional. This asymmetry is appropriate. First, providers acquire some governmental and institutional obligations of neutrality and equality. Second, generally, treatment regimens affect patients’ lives more directly and profoundly than they affect practitioners’ lives. This sometimes warrants introduction of patients’ religious beliefs into shared decision making and even some aspects of their treatment.Of the parts of the principle, the prescription of respect for patients’ religious views may be more controversial than the prohibition on physicians’ religious values from dominating the relationship. Yet, there are clear and uncontroversial cases in which accommodation of religious views is part of standard medical practice. Consider the role that religious values may have in patients’ care, which partially explains the appropriateness of hospital chaplains in comforting the sick. In many cases, the role of such religious values affects very little of the care provided by the medical professional, but in some cases, it may, as when, to enable religious, end-of-life rituals, one might temporarily reduce one’s otherwise preferred degree of pain-related sedation.Furthermore, patients may appropriately want to discuss their religious views with their medical providers directly—in a way that has little effect on medical aspects of their care. Such discussion is appropriate, in light of the vulnerability of patients to providers—given that patients entrust providers with important elements of their health care.67 In turn, providers should see the relationship as affording culturally competent medical care, including religiously competent care. A general capacity for such cultural sensitivity is something that all providers should cultivate.A different aspect of the role of religion in patient care is illustrated by the point that, in the right circumstances, providers’ sharing of their own spiritual beliefs and experiences can communicate understanding to patients that may be not only appropriate but virtuous.68 For instance, sharing one’s beliefs about and struggles in confronting death—when they appropriately connect with one’s patients and their families—may aid in showing patients and families concern appropriate to medical care. However, providers must be mindful of their abilities regarding such care. Different providers will understand different cultures and religions to different degrees. Aiming for fully virtuous care is appropriate where one may be confident of one’s abilities, but one can undermine care by acting on the assumption that one understands a patient’s culture when one does not. Likewise, one can easily overstep by not appropriately drawing on relevant elements already among the patient’s values but inappropriately intruding one’s own religious views in a way that violates the religious neutrality demanded of medical practitioners in such cases.Just as the value of neutrality extends from claims on governments to those on medical providers, so too does that of religious liberty. We suggest, in keeping with general consensus in medical ethics,

The patients’ religious liberty principle: Medical providers have a prima facie duty to honor the religiously based decision-making of their religious patients to the highest degree possible within reasonable interpretations of the harm and social equality principles.Patients’ religious values, like other values that are deep in their sense of identity, have strong claims to accommodation. This may justify allowing a medical harm to occur when, as with a religiously based rejection of a transfusion request, religious conviction demands the harm-inducing choice of the patient, and the patient is clearly mentally competent. It should be added, however, that not just any such refusal need be accommodated. Religious considerations, like other influences, may be irrational, and physicians may, in some circumstances, refuse to comply with religious-based demands that might lead to harm.Challenges can arise regarding the patients’ religious liberty principle when patients (and surrogates) who have decision-making capacity rely on hopes of miracles and make decisions based on such hopes—even in cases where providers (religious and nonreligious) believe the hope unfounded.69 For instance, evidence suggests that vast portions of the public believe that individuals in a persistent vegetative state might be saved by a divine intervention and further that related religious beliefs are associated with pursuing aggressive care that may be medically inadvisable (Widera et al., 2011). Here, the remarks above concerning the principle of practitioner religious neutrality are helpful. Competently engaging with patients’ beliefs can aid the relationship and subsequent decision making.70 Furthermore, important data suggest that certain religious patients are more likely to pursue aggressive end-of-life care, more likely to die in an ICU, and less likely to receive hospice care. However, some of these discrepancies are reduced when religious patients receive end-of-life discussions and spiritual support from the medical team (Balboni et al., 2013).Special cases in relation to the patient’s religious liberty principle include those of adults without decision-making capacity, as well as children. The former cases frequently arise in psychiatric care. Patients with psychosis often suffer delusions, frequently religious in nature. Sometimes such delusions affect their decision making, impairing their capacity in a way that might require treatment against their wishes. For instance, some patients are known to induce self-harm because they believe God is punishing them. In some cases, for the sake of safety such patients should be treated against their will. Nevertheless, respect for persons demands that their religious reasons at least be considered and not simply ignored, even if other values, such as prevention of harm, require that these reasons cannot be accommodated.71Of course, some adult patients who lack decision-making capacity require proxy decision-makers—as do children in many cases. For those cases, we propose observing a

Principle of the narrower scope of proxy consent: Other things equal, proxies may not authorize as wide a range72 of potentially harmful medical or experimental procedures for others for whom they are making decisions as for themselves.For instance, in keeping with judicial precedent,73 most agree that the providers ought to give a blood transfusion to children of Jehovah’s Witnesses in life-endangering need, even over parents’ religious objections. By contrast, adults with decision-making capacity are generally allowed to refuse blood transfusions, even at cost of life.Even if the liberty principle is ultimately limited in the above circumstances, the equality and neutrality principles are not; for it is neither the patient’s nor family’s particular beliefs as religious in light of which their wishes are rejected, but rather their incapacity as decision-makers. The same would be appropriate for a member of any religion or of any secular belief system who presented similar circumstances.VIII. CONCLUSIONPluralistic, liberal democracies face the challenge of balancing support of religious liberty, nonpreferential treatment of religion, avoidance of harm, and equal treatment of citizens. Not just any demand made in the name of religion should be protected by law, and even the democratic imperative to treat people equally does not justify wholesale elimination of religious accommodations. This paper presents standards aimed to help in balancing these competing demands, faced by democracies and the medical providers and institutions within them. Any plausible set of moral standards is, however, indeterminate regarding the resolution of certain difficult cases. Morally sound democracies, even as guided by sound standards, must resolve many policy issues—some perhaps perennially debatable—by situational deliberation.With this wide range of problems in mind, we have proposed a number of principles. These include the liberty, equality, neutrality, and social equality principles as applicable to governmental and institutional policies; the principle of secular rationale (or natural reason), which guides both deliberative discourse and resolution of disagreements; the principle of practitioner religious neutrality as applicable to provider–patient relationships; and the principle of the narrower scope of proxy consent, which applies to both medical practice and biomedical research. If these principles are defensible in the ways we have suggested, they can significantly contribute to the task of framing sound policies governing religion and medicine.ACKNOWLEDGMENTSThe paper has benefited from detailed, helpful comments from three anonymous reviewers for the journal and editorial remarks by Jeffrey Bishop. The authors have no conflicts of in regard to this paper. WRS receives support from the National Institute of Mental Health (grant R25MH119043).Footnotes 1.We believe that many of its conclusions extend to other societies, but we do not have space to address the complexity raised by such an extension. 2.This revival has featured renewed interest in intuitions by philosophers working in a variety of areas, including normative theory, moral epistemology, and epistemology writ large. For key works on ethical intuitionism, see Audi (1996, 2004), Huemer (2005, 2008), and Stratton-Lake (2002, 2011). On the epistemology of intuitions, see DePaul and Ramsey (1998), Chudnoff (2013), Booth and Rowbottom (2014), and Audi (2018). 3.Unlike many theories familiar to medical ethics that feature mid-level principles, some of which share our indebtedness to W. D. Ross and our interest in the possibility of reasons being shared across individuals with varying moral views (see n30 and n42), we make no claims that the justification of our principles stems from their being elements of a common morality. Cf. Beauchamp and Childress (2008) and Gert, Culver, and Clouser (2006). For discussion of Beauchamp and Childress that notes how their view evolved from one like ours in its interest in the possibility of shared justifications across moral views—though still unlike ours as not having an intuitionist theory of justification—see Mitchell (2014).4.Unfortunately, some contemporary discourse on the role of religion in bioethics passes over various important distinctions. For instance, some have claimed that, in secular philosophical discourse, the fundamental principles “are open to rational analysis and dissection” per se while religious claims are beyond such claims of rationality because of their dependence on authority (Smith, 2015). This suggestion appears to neglect the point that justificatory argument does not entail freedom from authority, as occurs when justification is drawn from moral testimony. (In fact, one of us has defended the rationality of religious commitment. See Audi, 2011b).Perhaps such authors believe that secular reasons have an a priori privileged role in bioethical discourse in the face of disagreement. Yet, we argue for a limited privilege below—not because of a difference in rationality of holding the beliefs in question, but rather because of what is owed to citizens in democratic governance.5.Of note, one could adopt our framework while abandoning our conclusions by avoiding various supplemental views on which we draw.6.Cf., e.g., Anderson (1999).7.On pluralism generally, see Rawls (2005), Cohen (2009), and Gutmann and Thompson (1996, 2004), among others. Of course, conflicts about value in pluralistic societies do not uniquely stem from differences about religion. Nevertheless, religious issues merit particular attention because, for many citizens, religious beliefs ground many moral beliefs and, among their orienting convictions, are likely to be both most important to their sense of identity and a source of their deepest commitments. For discussion of why these particular values are of particular importance, see Audi (2011a, 42–3).8.Much of this section summarizes points from Audi (1996, 2004, 2015). We thank two anonymous referees for this journal as well as Jeffrey Bishop for pressing us to clarify the moral epistemology (described in this section) and the political epistemology (described at the end of the second), on which our substantive view draws.9.The term is owed to Nagel (1986), who himself appears to draw on intuitionist moral epistemology—if not quite in the way we outline.This complaint, or ones very much like it, is particularly common among religiously oriented authors in bioethics. For such worries, see Camosy (2012, 2014, 2015), Engelhardt (2017, 15), Stempsey (2012), and Bishop (2011, esp. text surrounding 23 and 48).10.Although Camosy is rightfully skeptical of Murphy’s (2012) notion of secularity, on which see n28 below, his overall position suggests that he is skeptical of other notions of secularity—such as that defended here—as well.11.Indeed, we believe that traditions often have vague and overlapping boundaries. Moreover, internecine debates between positions within a tradition can be as stark as those between traditions.12.Two points are of note. First, the term “intuitions” can, depending on context, have a number of other referents, including those of mental states—so-called seemings—that can phenomenologically ground apprehending such propositions as justified. (For discussion of different senses of intuition, see Audi, 2015, 59–62.) Second, for a full account of intuition, some explanation of the conditions of comprehending apprehension is needed, but to offer one here would take the paper far afield.13.For a detailed account of adequate understanding, see Audi (2018).14.One may reconstruct nearly any argument in deductive form, given suitably permissive bridge premises, but those frequently need support by induction or intuition themselves. For instance, one could reconstruct the sort of defense against counterexample suggested above as follows:1. If counterexample C fails, then p is true.2. C fails.C: p is true.Clearly (1) draws on another justification. We believe that intuition can offer justification for such bridge premises.Similarly, one could reconstruct the sort of illustrative support we discuss above for intuitions with arguments as some form of induction or abduction, but while induction or abduction may be logically acceptable in certain circumstances, that reconstruction would fail to portray the direction of justification of the arguments described above. In the arguments as described, adequate reflection on the proposition conveys justification.15.A different form of this complaint is charged against liberalism—that it requires neutrality that somehow excludes certain individuals, such as those with religious beliefs; we address this—though briefly and incompletely—in Section II.16.For one pragmatist view on which it would, see Annis (1978). For convincing criticism of this sort of view, see Timmons (1999, 188–9) and Moser (1985, Ch. 2).17.Furthermore, intuitive principles may be incorporated into theories in other ways, such as if theoretic principles show how the reasons provided by various intuitive (or even self-evident) principles can be compared in different contexts (Audi, 2012).18.One might even think them so uncontroversial in biomedicine as to be unhelpful, but as we shall see, issues of equal treatment raise issues of prioritization.19.On Mill, see Brink (2013). On the harm principle, see Feinberg (1985, 1987, 1989, 1990).20.Some might argue that the concerns mentioned above about the harm principle show not that the principle is problematic, but rather that the notion of harm should be “moralized”—that is, understood in terms of moral notions—or otherwise broadened (Jacobson, 2000; Brink, 2013, 143–6, 187–90). For instance, one might take threats to equality as a type of harm—as might be commonplace in jurisprudential discussion of “dignity harms” (e.g., Greenawalt, 2016). They might further claim that the liberty principle alone, with a broad understanding of the harm principle, may suffice to address these issues. For the purposes of this paper, we bear these complexities in mind but freely refer to the above principles as where the context makes their application adequately clear.21.Cf. the “social egalitarian” views of Anderson (1999) and Scheffler (2010, Chs. 7 and 8). Arguably, their views of equality are stronger than—though not incompatible with—that which we rely on here.22.Two complications are worth noting. First, even given that the obligation in question is prima facie and thus defeasible, there can be reasonable disagreement about the extent to which governments should promote, as opposed to simply protect, equal status before the law or more far-reaching elements in social relations among citizens, including equality in economic power and in access to political voice.Second, reasonable disagreement may emerge regarding how the liberty principle and the social equality principle accommodate one another, including whether they are competing prima facie principles or whether the liberty principle should be revised to provide for protection of religious liberty consistently with reasonable interpretations of both the harm principle and the social equality principle. For purposes of length and because the choice between these positions does not, in itself, make a difference to ultima facie obligation (as the principles in question are only prima facie), we here leave this complex problem for further reflection.23.There are many ways that such a principle could be satisfied in addressing these problems and many others for which the principle requires redress. Arguably, the best interpretation of the principle depends on delineating all of these in detail, but here we will focus on issues regarding religion in biomedical ethics.24.For earlier presentation of this principle, see Audi (2011a, 65–6) and similarly, Audi (2000, Ch. 4–5). Of note, judgment is required in applying the principle of secular rationale, in ascertaining both when a reason is secular (even given the clarification of the meaning of secularity that we detail in the following) and when a reason is adequate.25.In addition to the related principles in the views discussed in the following, see also the principles defended by Greenawalt (1988, 1995).26.For some discussion of the role of respect in deliberative democracy and justificatory liberalism (though under the name of political liberalism), see Gutmann and Thompson (2004, 79 et passim) and Larmore (2015), respectively.27.For helpful discussion of such tolerance in such an environment, see Scanlon (2003, 198–200), who insightfully notes that challenges to prevailing norms of toleration (both those with and those without normative support) can become a means to political support and serve as a “litmus test” for society’s respect of a group. Perhaps many recent invocations of conscientious objection and complicity display the tendencies Scanlon notes. Cf., e.g., Catholic organizations’ objections to having to file a form in order to opt out of requirements to provide healthcare coverage to employees that includes contraceptive coverage as in Little Sisters of the Poor Home v. Burwell (2015).28.Unfortunately, secular may be a term of some confusion, given the many meanings that it has been claimed to have. This is common in bioethical discourse as elsewhere. For instance, in defending “irreligious bioethics,” Murphy, quoting Simpson and Weiner (1989, XIV, 849), claims he uses secular “to signify morality “based solely on regard to the well-being of mankind in the present life, to the exclusion of all considerations drawn from the belief in God or in a future state”” (2012, 4n2). Yet, clearly secular values extend beyond moral ones, and furthermore, the secular, moral values are not limited to those “based solely” on well-being, because they include issues of rights, duties, special relationships, and various other sources. We believe the notion of secularity we employ is clearer. Moreover, it does not depend on a covert hostility to religion.29.Hence, secular reasons share many features with what some (often in the Thomistic tradition) have called natural reasons. See Audi (2009) for further discussion.30.Perhaps the most important concerns about it are charges, raised by critics of it and other principles of restraint, that restraint principles are unfair to religious persons. For review, see Vallier (2014, Ch. 2). Dealing with all of these matters here would take us afield, but Vallier notes ways in which the principle of secular rationale is less demanding than critics often suppose. We take the issues raised in the text below to be important in this matter. For fuller discussion and response to such criticisms regarding the principle of secular rationale, see Audi (2011a, 70 et passim). Vallier argues that Audi (2011a) imposes many further principles that would add to the restraints on religious citizens; we cannot respond here, but note that these further principles are not part of the present framework.One important criticism is that the principle of secular rationale, unlike many related principles, requires restraint on only religious reasons—as opposed to any nongenerally shared or nongenerally accessible reasons. In this way, it may be more liable to objections of placing unfair burdens on religious citizens than on other principles of restraint. However, we believe that the principle of secular rationale—especially given its evidential adequacy condition—coheres with a number of broader principles that require advocating accessible reasons more generally. (Yet, it does not imply that religious reasons are necessarily “inaccessible.”) Unfortunately, developing the theoretical resources for capturing the appropriate notions of accessibility and shareability—and the standards relevant to each—lies well beyond the scope of this essay (though we gesture at some of the relevant ideas in n42 below).31.It is even compatible with prima facie requirements for religious citizens to bring their religion to bear in public deliberation. One of us has defended such a requirement, for certain kinds of cases; see Audi (2011a, 89). The other has qualms about such a requirement—as many religious citizens may find their particular religious traditions silent, indeterminate, or misguided on various matters that may arise.32.The latter two serve as important examples in others’ work on pluralism and justice, including that of Rawls (2005, 249 et passim), Weithman (2002, Ch. 2), and Vallier (2014, 57 et passim).33.For similar considerations regarding prominent deliberative principles in bioethics, albeit without specifically religious reasons in mind, see Smith (2018a, 2018b).34.Cf. Gutmann and Thompson (2004, 7), Cohen (2009, 16, 160), and Weithman (2005, 263–5).35.Deliberative democrats disagree about the constituency to whom reasons must be offered.36.We draw this gloss from Vallier (2014, 24, 2018)—although we alter his formulation in a few ways. Furthermore, we take Rawls’s notion of legitimacy to be importantly distinct from others in ways that fundamentally alter the claim. See Weithman (2015).37.For an introduction to public justification liberalism that emphasizes the role of religion, see Vallier (2014, Ch. 1). Lister (2013) provides helpful discussion of many of the most notable justificatory liberal positions—though under the moniker of political liberalism.38.Rawls is arguably the father of justificatory liberalism and counts himself as a deliberative democrat (2005, 448 et passim). Many deliberative democrats have drawn on his view of public reason. Many justificatory liberals, following Rawls, also adopt deliberative democracy—though Gaus (2010, esp. 387) is a notable exception.39.On Rawls’s duty of civility, see Weithman (2002, Ch. 7) and Quong (2010, 41–3, Ch. 9). For specific criticism of the duty of civility, see Audi (2011a, 63–4). For discussion of restraint in Rawls and others, see Eberle (2002, esp. Ch. 5), Larmore (2015), Lister (2013), and Vallier (2014, 31 et passim and Ch. 2).40.We here invoke Rawlsian terms for purposes of making the point in familiar language without comment on how it functions in his specific view, which is more complicated on this point.41.Cf. Cohen (2009, 24) and Gutmann and Thompson (2004, Ch. 3).42.Furthermore, we avoid the critical concern, which justificatory liberals face, as to whether justified law or policy depends on reasons all citizens can share, or whether such law or policy might be justified by convergence of various different justifications of different citizens. (On this debate, see Vallier, 2014.) However, our general framework, resting on a plurality of intuitively justified principles, creates opportunities for rational citizens to have access to shared justification for laws, even when their fundamental moral theories, from which they might draw further justification, diverge. This does not ensure a shared justification or a convergence on a law from separate justifications, but it does provide resources for stabilizing forces of shared justification, which many justificatory liberals and deliberative democrats have taken as a central aspiration. Furthermore, we think that the possibility of having access to such shared justification may be key to articulating a notion of ideals of democratic relations, similar to those of “civic friendship” and “the ideal of democratic governance” that some Rawlsians have advocated without commitment to justificatory liberalism that is critical to such views. See Lister (2013, Ch. 5) and Weithman (2011), respectively, on these notions.43.As we argue, some of these supplementary principles are supported by the same values as those that underwrite the principles above—even when the concern is not with governmental accommodation of religion.44.Cf. American Medical Association (2016), American College of Obstetricians and Gynecologists (2007), Brock (2008), and Wicclair (2011, Ch. 3). Some debate whether providers have a duty to inform and refer or rather merely to ensure that patients have the relevant information and access to the relevant treatment through another (Wicclair, 2011, Ch. 3). The upshot of such a distinction may be context-dependent and relative to the healthcare system in question. In the United States, given the complexity of multipayer and multiprovider systems, we believe that, generally, any reasonable duty to ensure requires informing and referring. It might be that in simpler, more unified systems, providers need not literally inform and refer because the integrated system ensures this.45.In addition to other political principles that may do so as well.46.And, mutatis mutandis, in keeping with the neutrality principle, freedoms regarding secular beliefs that may conflict with fulfilling medical needs.47.Some object to requiring conscientious objectors to ensure access to interventions they see as wrong makes them complicit in those actions. While the variety of positions in the theory of complicity (Kamm, 1999; Kutz, 2000) cannot be fully reviewed here, such arguments generally appeal to an understanding of the natural law tradition, on which actions with immoral effects are permissible when they are not intrinsically wrong, their immoral effects are neither intended nor a means to the good effects, and their good effects are (appropriately) proportional to their immoral effects (Oderberg, 2017). Now it is doubtful that the first two conditions make ensuring access complicit. Ensuring access is a means to various goods, including maintenance of trust in providers and the medical community, collective assurances that others will not fail to ensure services that they do not find objectionable, and general civic goods of healthcare provision. Ensuring access is not intrinsically wrong, and providers need not intend the interventions objected to, nor are those interventions a means to the goods in question.Furthermore, the proportionality condition does not render ensuring access complicit. The goods in question are weighty, particularly for providers with special duties to patients. Some claim that proportionality is also a matter of causal proximity between a potentially complicit action and its immoral effects, as well as the indispensability of the former to the latter (Oderberg, 2004, 2017, Sulmasy, 2008). However, there are many steps between referral for a service and the performance of the service. Furthermore, many invoking the complicity concern also claim that conscientious objections—of the kind we reject—often pose mere “inconvenience[s]” to patients and that alternative access is generally available (Sulmasy, 2008, 2017). This casts doubt on the indispensability concern.48.Cf. Savulescu (2006).49.Cf. Stahl and Emanuel (2017), Savulescu and Schuklenk (2017), and Schuklenk and Smalling (2017).50.We hasten to note that the brief remarks here are not a complete account of the scope, content, or sources of professional duties, but rather merely the most pertinent parts of one to the issue at hand. For instance, medical professionals’ duties are also explained partly as specifications of more general duties that arise through interaction of healthcare professionals with their patients—e.g., by the application of a duty of rescue in cases where patients face emergent needs.51.The partial source of providers’ special duties in societal obligations might be challenged, particularly by those more familiar with views that base such duties in the vulnerability of medical illness and providers’ special promises. Cf. Pellegrino (2001). We have doubts that such views can adequately capture the extension of special duties and doubt that promises have the correct content to ground the relationship in question, but we cannot pursue the matter here. We also note that other prominent accounts have relied on society as part of the source of providers’ duties, though in ways different from those we use here. Hence, some specifics of our account are distinctive, but the general features are within the mainstream of the literature on providers’ special obligations. Cf. Daniels (1991, esp. 42–6, 2008, Ch. 8, esp. 223–6), Buchanan (2009), and Brock (2008, 191–2).52.Cf. the view of some advocates of expansive objection rights that medical licensure merely grants providers permissions to act in ways they think clinically appropriate, rather than imposing duties on them (Sulmasy, 2017). Such writers are correct to note a need for “discretionary space” for providers to use their judgment regarding how to do so (Sulmasy, 2017), but this space is limited because providers’ special expertise largely regards technical matters. Perhaps providers have some moral expertise in matters that they encounter regularly as part of medical practice, but this expertise is limited and does not necessarily provide claims that override others’ claims to moral knowledge.53.See Little Sisters of the Poor Home v. Burwell (2015). For discussion of issues in a related case, see Audi (2014).54.For some discussion of such legal issues, see Greenawalt (2016, 2017).55.Whether or not they have mental states.56.For discussions of such values in religious organizations, see Wildes (1991, 1997) and Iltis (2001).57.Note the differences between this distinction and others invoked in the literature, including that between “independent pharmacies and large retail chains” (Wicclair, 2011, 141–2) and that between for-profit and not-for-profit entities.58.Indeed, institutions often play a critical role in how individual providers might do so. Unfortunately, relevant data suggest that such institutions often fail to supply sufficient information about alternatives to patients (Smugar, Spina, and Merz, 2000).59.Cf. Minerva (2015, 2017).60.One could argue that such actions would only be permissible with state approval. We take no stand on this issue here.61.Others who have advanced similar positions have suggested they are alternatives to the moderate view of conscientious objection supported here (Minerva, 2015, 2017). Yet, the views, as we understand them, are compatible. The claims about institutions’ obligations do not imply a rejection of providers’ prima facie liberties, as understood by the moderate view.62.See Redden (2016), Freedman, Landy, and Steinauer (2008), and American Civil Liberties Union (2016). Perhaps the most well-known case is that of Savita Halappanavar, who died in Ireland due to sepsis, while her medical team waited for the fetal heartbeat to stop in the setting of miscarriage. They did so in light of the Irish laws at the time, despite her request for abortion. This case proved influential in leading to reform of Irish abortion laws (Specia, 2018).63.Uniform treatment, in different terms.64.On religious concerns about such bioprosthetic materials, see Easterbrook and Maddern (2008), Goyal, Goyal, and Brittberg (2013), Jenkins et al. (2010), and Scharman et al. (2017). Importantly, one must note that objections to such procedures may be voiced for secular reasons as well; for example, vegans may well object to the use of certain biological surgical products.65.See Easterbrook and Maddern (2008).66.Cf. the parallel principle of clerical neutrality (Audi, 2000, 177).67.Of course, there are limits to such materials. For instance, while discussion of religious activities at general, outpatient checkups may be important to understanding patients’ general well-being, patients ought not overextend appointments past their allotted time for lengthy religious discussion that does not relate to medical care. In so doing, they would show disrespect both to other patients and to the physician.68.For helpful reflections on such issues, see Kuczewski (2007).69.A related, and perhaps more active, literature concerns what accommodations neurologists should or would be willing to provide to patients who voiced religious-based objection to decelerating care after a determination of brain death. See, e.g., Lewis and Greer (2017) and Lewis et al. (2016).70.For helpful discussions of how to do so, see Cooper et al. (2014) and Partain, Ingram, and Strand (2017).71.For discussion of some of these cases, see Boazak et al. (2018).72.The range here should be understood to cover several types of cases that patients and proxies may encounter. Thus, the principle limits proxies in some of these cases. In a given case, there may be no difference between what a proxy and a patient could authorize. For instance, in many cases where the patient has been rendered incapacitated and decisions about potential end of life are at stake, proxies (when exercising decision through appropriate means) have authority to authorize any of the choices that the patient would have, were they able to state their preferences—including eliminating life-support, advocating for or against extraordinary measures, and others.73.See, e.g., Jehovah’s Witnesses v King County Hospital, U.S. Supreme Court (1968). For a helpful discussion of precedent across several countries, see Woolley (2005).REFERENCES

American Civil Liberties Union . 2016. Health Care Denied: Patients and Physicians Speak Out about Catholic Hospitals and the Threat to Women’s Health and Lives [On-line]. Available: https://www.aclu.org/report/report-health-care-denied (accessed October 13, 2020).

American College of Obstetricians and Gynecologists . 2007. ACOG Committee Opinion No. 385 November 2007: The limits of conscientious refusal in reproductive medicine. Obstetrics and Gynecology 110(5):1203. [PubMed] [Google Scholar]

American Medical Association . 2016. Opinion 1.1.7. AMA Code of Medical Ethics [On-line]. Available: https://www.ama-assn.org/delivering-care/ama-code-medical-ethics (accessed October 13, 2020).

Anderson, E. 1999. What is the point of equality? Ethics 109(2):287–337. [Google Scholar]

Annis, D. B. 1978. A contextualist theory of epistemic justification. American Philosophical Quarterly 15(3):213–9. [Google Scholar]

Audi, R. 1996. Intuitionism, pluralism, and the foundations of ethics. In Moral Knowledge, eds. Sinnott-Armstrong W. and Timmons M., 101–36. Oxford, United Kingdom: Oxford University Press. [Google Scholar]———. 2000. Religious Commitment and Secular Reason. Cambridge, United Kingdom: Cambridge University Press. [Google Scholar]———. 2004. The Good in the Right: A Theory of Intuition and Intrinsic Value. Princeton, NJ: Princeton University Press. [Google Scholar]———. 2009. Natural reason, natural rights, and governmental neutrality toward religion. Religion and Human Rights 4(2–3):157. [Google Scholar]———. 2011a. Democratic Authority and the Separation of Church and State. Oxford, United Kingdom: Oxford University Press. [Google Scholar]———. 2011b. Rationality and Religious Commitment. Oxford, United Kingdom: Oxford University Press. [Google Scholar]———. 2012. Kantian intuitionism as a framework for the justification of moral judgments. In Oxford Studies in Normative Ethics. ed. Timmons M., Vol. 2. Oxford, United Kingdom: Oxford University Press. [Google Scholar]———. 2014. Church-state separation, healthcare policy, and religious liberty. Journal of Practical Ethics 2(1):1–23. [Google Scholar]———. 2015. Intuition and its place in ethics. Journal of the American Philosophical Association 1(1):57–77. [Google Scholar]———. 2018. Understanding, self-evidence, and justification. Philosophy and Phenomenological Research 99(2):267–525. [Google Scholar]

Balboni, T. A., Balboni M., Enzinger A. C., Gallivan K., Paulk E., Wright A., Steinhauser K., VanderWeele T. J., and Prigerson H. G.. 2013. Provision of spiritual support to patients with advanced cancer by religious communities and associations with medical care at the end of life. JAMA Internal Medicine 173(12):1109–17. [PMC free article] [PubMed] [Google Scholar]

Beauchamp, T. L., and Childress J. F.. 2008. Principles of Biomedical Ethics. 6th ed. Oxford, United Kingdom: Oxford University Press. [Google Scholar]

Bishop, J. P. 2011. Anticipatory Corpse: Medicine, Power, and the Care of the Dying. Notre Dame, IN: University of Notre Dame Press. [Google Scholar]

Boazak, M., Peterson M. J., Smith W. R., Hudson Z., and Schwartz A. C.. 2018. “You aren’t going to cut on me!” Urgent medical decisions for patients with schizophrenia: How we decided. Psychosomatics 58(5):506–11. [PubMed] [Google Scholar]

Booth, A. R., and Rowbottom D. P., eds. 2014. Intuitions. Oxford, United Kingdom: Oxford University Press. [Google Scholar]

Brink, D. O. 2013. Mill’s Progressive Principles. Oxford, United Kingdom: Oxford University Press. [Google Scholar]

Brock, D. W. 2008. Conscientious refusal by physicians and pharmacists: Who is obligated to do what, and why? Theoretical Medicine and Bioethics 29(3):187–200. [PubMed] [Google Scholar]

Buchanan, A. E. 2009. Is there a medical profession in the house? In Justice and Health Care: Selected Essays, ed. Buchanan A., 175–202. Oxford, United Kingdom: Oxford University Press. [Google Scholar]

Camosy, C. 2012. The role of normative traditions in bioethics. The American Journal of Bioethics 12(12):13–5. [PubMed] [Google Scholar]

———..

2014. Can bioethics be done without theology? Practical Ethics Blog [On-line]. Available: http://blog.practicalethics.ox.ac.uk/2014/11/can-bioethics-be-done-without-theology-guest-post-from-charles-camosy/ (accessible October 13, 2020).———. 2015. No view from nowhere: The challenge of grounding dignity without theology. Journal of Medical Ethics 41(12):938–9. [PubMed] [Google Scholar]

Chudnoff, E. 2013. Intuition. Oxford, United Kingdom: Oxford University Press. [Google Scholar]

Cohen, J. 2009. Philosophy, Politics, Democracy: Selected Essays. Cambridge, MA: Harvard University Press. [Google Scholar]

Cooper, R. S., Ferguson A., Bodurtha J. N., and Smith T. J.. 2014. AMEN in challenging conversations: Bridging the gaps between faith, hope, and medicine. Journal of Oncology Practice 10(4):e191–5. [PMC free article] [PubMed] [Google Scholar]

Daniels, N. 1991. Duty to treat or right to refuse? Hastings Center Report 21(2):36–46. [PubMed] [Google Scholar]———. 2008. Just Health: Meeting Health Needs Fairly. Cambridge, United Kingdom: Cambridge University Press. [Google Scholar]

DePaul, M., and Ramsey W., eds. 1998. Rethinking Intuition: The Psychology of Intuition and its Role in Philosophical Inquiry. Lanham, MD: Rowman & Littlefield Publishers. [Google Scholar]

Easterbrook, C., and Maddern G.. 2008. Porcine and bovine surgical products: Jewish, Muslim, and Hindu perspectives. Archives of Surgery 143(4):366–70. [PubMed] [Google Scholar]

Eberle, C. J. 2002. Religious Conviction in Liberal Politics. Cambridge, United Kingdom: Cambridge University Press. [Google Scholar]

Engelhardt, H. T., Jr.

2017. After God: Morality & Bioethics in a Secular Age. Yonkers, NY: St. Vladimir’s Seminary Press. [Google Scholar]

Feinberg, J. 1985. Harm to Others: The Moral Limits of the Criminal Law. Vol. 1. Oxford, United Kingdom: Oxford University Press. [Google Scholar]———. 1987. Offense to Others: The Moral Limits of the Criminal Law. Vol. 2. Oxford, United Kingdom: Oxford University Press. [Google Scholar]———. 1989. Harm to Self: The Moral Limits of the Criminal Law. Vol. 3. Oxford, United Kingdom: Oxford University Press. [Google Scholar]———. 1990. Harmless Wrongdoing: The Moral Limits of the Criminal Law. Vol. 4. Oxford, United Kingdom: Oxford University Press. [Google Scholar]

Freedman, L. R., Landy U., and Steinauer J.. 2008. When there’s a heartbeat: Miscarriage management in Catholic-owned hospitals. American Journal of Public Health 98(10):1774–8. [PMC free article] [PubMed] [Google Scholar]

Gaus, G. 2010. The Order of Public Reason: A Theory of Freedom and Morality in a Diverse and Bounded World. Cambridge, United Kingdom: Cambridge University Press. [Google Scholar]

Gert, B., Culver C. M., and Clouser K. D.. 2006. Bioethics: A Systematic Approach. Oxford, United Kingdom: Oxford University Press. [Google Scholar]

Goyal, D., Goyal A., and Brittberg M.. 2013. Consideration of religious sentiments while selecting a biological product for knee arthroscopy. Knee Surgery, Sports Traumatology, Arthroscopy 21(7):1577–86. [PubMed] [Google Scholar]

Greenawalt, K. 1988. Religious Convictions and Political Choice. Oxford University Press on Demand. [Google Scholar]———. 1995. Private Consciences and Public Reasons. Oxford, United Kingdom: Oxford University Press. [Google Scholar]———. 2016. Exemptions: Necessary, Justified, or Misguided? Cambridge, MA: Harvard University Press. [Google Scholar]———. 2017. When Free Exercise and Nonestablishment Conflict. Cambridge, MA: Harvard University Press. [Google Scholar]

Gutmann, A., and Thompson D.. 1996. Democracy and Disagreement. Cambridge, United Kingdom: Cambridge University Press. [Google Scholar]———. 2004. Why Deliberative Democracy? Princeton, NJ: Princeton University Press. [Google Scholar]

Hart, H. L. A. 1982. Legal rights. In Essays on Bentham. Jurisprudence and Political Theory, ed. Hart H. L. A., 162–93. Oxford, United Kingdom: Oxford University Press. [Google Scholar]

Huemer, M. 2005. Moral Intuitionism. New York, NY: Palgrave Macmillan. [Google Scholar]———. 2008. Revisionary intuitionism. Social Philosophy and Policy 25(1):368–92. [Google Scholar]

Iltis, A. S. 2001. Institutional integrity in Roman Catholic health care institutions. Christian Bioethics 7(1):95–103. [PubMed] [Google Scholar]

Jacobson, D. 2000. Mill on liberty, speech, and the free society. Philosophy & Public Affairs 29(3):276–309. [Google Scholar]

Jenkins, E. D., Yip M., Melman L., Frisella M. M., and Matthews B. D.. 2010. Informed consent: Cultural and religious issues associated with the use of allogeneic and xenogeneic mesh products. Journal of the American College of Surgeons 210(4):402–10. [PubMed] [Google Scholar]

Kamm, F. M. 1999. Responsibility and collaboration. Philosophy & Public Affairs 28(3):169–204. [Google Scholar]———. 2007. Rights beyond interests. In Intricate Ethics: Rights, Responsibilities, and Permissible Harm, ed. Kamm F. M., 237–85. Oxford, United Kingdom: Oxford University Press. [Google Scholar]

Kuczewski, M. G. 2007. Talking about spirituality in the clinical setting: Can being professional require being personal? The American Journal of Bioethics 7(7):4–11. [PubMed] [Google Scholar]

Kutz, C. 2000. Complicity: Ethics and Law for a Collective Age. Cambridge Studies in Philosophy and Law. Cambridge: Cambridge University Press. [Google Scholar]

Larmore, C. 2015. Political liberalism: Its motivations and goals. In Oxford Studies in Political Philosophy, eds. Sobel D., Vallentyne P., and Wall S., Vol. 1, 63–87. Oxford, United Kingdom: Oxford University Press. [Google Scholar]

Lewis, A., Adams N., Varelas P., Greer D., and Caplan A.. 2016. Organ support after death by neurologic criteria. Results of a Survey of US Neurologists 87(8):827–34. [PubMed] [Google Scholar]

Lewis, A., and Greer D.. 2017. Current controversies in brain death determination. Nature Reviews Neurology 13(8):505–9. [PubMed] [Google Scholar]

Lister, A. 2013. Public Reason and Political Community. London, United Kingdom: Bloomsbury Publishing. [Google Scholar]

MacIntyre, A. 2007. After Virtue: A Study in Moral Theory. 3rd ed. South Bend, IN: University of Notre Dame Press. [Google Scholar]

Mill, J. S. 1859/1978. On Liberty. Indianapolis, IN: Hackett. [Google Scholar]

Minerva, F. 2015. Conscientious objection in Italy. Journal of Medical Ethics 41(2):170–3. [PubMed] [Google Scholar]———. 2017. Conscientious objection, complicity in wrongdoing, and a not-so-moderate approach. Cambridge Quarterly of Healthcare Ethics 26(1):109–19. [PubMed] [Google Scholar]

Mitchell, L. A. 2014. Major changes in principles of biomedical ethics: A review of seven editions of Beauchamp and Childress. National Catholic Bioethics Quarterly 14(3):459–75. [Google Scholar]

Moser, P. K. 1985. Empirical Justification. Dordrecht, The Netherlands: Springer. [Google Scholar]

Murphy, T. F. 2012. In defense of irreligious bioethics. The American Journal of Bioethics 12(12):3–10. [PubMed] [Google Scholar]

Nagel, T. 1986. The View from Nowhere. Oxford, United Kingdom: Oxford University Press. [Google Scholar]

Oderberg, D. S. 2004. The ethics of co-operation in wrongdoing. Royal Institute of Philosophy Supplement 54:203–27. [Google Scholar]———. 2017. Further clarity on cooperation and morality. Journal of Medical Ethics 43(4):192–200. [PubMed] [Google Scholar]

Partain, D. K., Ingram C., and Strand J. J.. 2017. Providing appropriate end-of-life care to religious and ethnic minorities. Mayo Clinic Proceedings 92(1):147–52. [PubMed] [Google Scholar]

Pellegrino, E. D. 2001. The internal morality of clinical medicine: A paradigm for the ethics of the helping and healing professions. Journal of Medicine and Philosophy 26(6):559–79. [PubMed] [Google Scholar]

Quong, J. 2010. Liberalism without Perfection. Oxford, United Kingdom: Oxford University Press. [Google Scholar]

Rawls, J. 2005. Political Liberalism: Expanded Edition. New York: Columbia University Press. [Google Scholar]

Redden, M. 2016. Abortion ban linked to dangerous miscarriages at Catholic hospital, report claims. The Guardian [On-line]. Available: https://www.theguardian.com/us-news/2016/feb/18/michigan-catholic-hospital-women-miscarriage-abortion-mercy-health-partners (accessed October 13, 2020).

Ripstein, A. 2006. Beyond the harm principle. Philosophy & Public Affairs 34(3):215–45. [Google Scholar]

Ross, W. D. 1930/2002. The Right and the Good, ed. Stratton-Lake Philip. Oxford, United Kingdom: Oxford University Press. [Google Scholar]

Savulescu, J. 2006. Conscientious objection in medicine. BMJ 332(7536):294–7. [PMC free article] [PubMed] [Google Scholar]

Savulescu, J., and Schuklenk U.. 2017. Doctors have no right to refuse medical assistance in dying, abortion or contraception. Bioethics 31(3):162–70. [PMC free article] [PubMed] [Google Scholar]

Scanlon, T. M. 2003. The difficulty of tolerance. In The Difficulty of Tolerance: Essays in Political Philosophy, ed. Scanlon T. M., 187–201. Cambridge, United Kingdom: Cambridge University Press. [Google Scholar]

Scharman, C. D., Burger D., Shatzel J. J., Kim E., and DeLoughery T. G.. 2017. Treatment of individuals who cannot receive blood products for religious or other reasons. American Journal of Hematology 92(12):1370–81. [PubMed] [Google Scholar]

Scheffler, S. 2010. Equality and Tradition: Questions of Value in Moral and Political Theory. New York: Oxford University Press. [Google Scholar]

Schuklenk, U., and Smalling R.. 2017. Why medical professionals have no moral claim to conscientious objection accommodation in liberal democracies. Journal of Medical Ethics 43(4):234–40. [PubMed] [Google Scholar]

Shapiro, S. 2014. Massively shared agency. In Rational and Social Agency. Essays on the Philosophy of Michael Bratman, eds. Vargas M. and Yaffe G., 257–93. New York: Oxford University Press. [Google Scholar]

Simpson, J. A., and Weiner E. S. C.. 1989. The Oxford English Dictionary. Oxford, United Kingdom: Clarendon Press. [Google Scholar]

Smith, K. R. 2015. Religion, secular medicine and utilitarianism: A response to Biggar. Journal of Medical Ethics 41(11):867–9. [PubMed] [Google Scholar]

Smith, W. R. 2018a. Legitimacy in bioethics: Challenging the orthodoxy. Journal of Medical Ethics 44(6):416–23. [PubMed] [Google Scholar]———. 2018b. Saving environmental justice from proceduralism. The American Journal of Bioethics 18(3):55–6. [PubMed] [Google Scholar]

Smugar, S. S., Spina B. J., and Merz J. F.. 2000. Informed consent for emergency contraception: Variability in hospital care of rape victims. American Journal of Public Health 90(9):1372–6. [PMC free article] [PubMed] [Google Scholar]

Specia, M. 2018, May 27. How Savita Halappanavar’s death spurred Ireland’s abortion rights campaign. The New York Times [On-line]. Available: https://www.nytimes.com/2018/05/27/world/europe/savita-halappanavar-ireland-abortion.html (accessed October 14, 2020).

Stahl, R. Y., and Emanuel E. J.. 2017. Physicians, not conscripts – Conscientious objection in health care. New England Journal of Medicine 376(14):1380–5. [PubMed] [Google Scholar]

Stempsey, W. E. 2012. Bioethics needs religion. The American Journal of Bioethics 12(12):17–8. [PubMed] [Google Scholar]

Stratton-Lake, P., ed. 2002. Ethical Intuitionism: Re-evaluations. Oxford, United Kingdom: Oxford University Press. [Google Scholar]

———..

2011. Recalcitrant pluralism. Ratio 24(4):364–83. [Google Scholar]

Sulmasy, D. P. 2008. What is conscience and why is respect for it so important? Theoretical Medicine and Bioethics 29(3):135–49. [PubMed] [Google Scholar]———. 2017. Tolerance, professional judgment, and the discretionary space of the physician. Cambridge Quarterly of Healthcare Ethics 26(1):18–31. [PubMed] [Google Scholar]

Timmons, M. 1999. Morality without Foundations: A Defense of Ethical Contextualism. Oxford, United Kingdom: Oxford University Press. [Google Scholar]

Tuomela, R. 2013. Social Ontology: Collective Intentionality and Group Agents. Oxford, United Kingdom: Oxford University Press. [Google Scholar]

U.S. Congress . 1993. Religious Freedom Restoration Act of 1993. In 42 U.S.C.A. § 2000bb-1.

U.S. Court of Appeals, 10th Circuit . 2015. Little Sisters of the Poor Home v. Burwell. 794. No. 13-1540. 1151. [Google Scholar]

U.S. Supreme Court . 1968. Jehovah’s Witnesses v King County Hospital. 278 F. Supp. 488 (W.D. Wash. 1967) aff’d 390 U.S. 598 (1968). [Google Scholar]———. 2010. Citizens United v. Federal Election Commission. 558. No. 8-205. [Google Scholar]———. 2014. Burwell v. Hobby Lobby Stores, Inc. 134. No. 13-354. 2751. [Google Scholar]

Vallier, K. 2014. Liberal Politics and Public Faith: Beyond Separation. New York: Routledge. [Google Scholar]———. 2018. Public justification. In The Stanford Encyclopedia of Philosophy, ed. Zalta E. N.. Available: https://plato.stanford.edu/entries/justification-public/ (accessed October 14, 2020). [Google Scholar]

Weithman, P. J. 2002. Religion and the Obligations of Citizenship. Cambridge, United Kingdom: Cambridge University Press. [Google Scholar]

Weithman, P. 2005. Deliberative character. Journal of Political Philosophy 13(3):263–83. [Google Scholar]———. 2011. Why Political Liberalism?: On John Rawls’s Political Turn. Oxford, United Kingdom: Oxford University Press. [Google Scholar]———. 2015. Legitimacy and the project of political liberalism. In Rawls’s Political Liberalism, eds. Brooks T. and Nussbaum M. C., 73–112. New York: Columbia University Press. [Google Scholar]

Wendler, D. 2010. Are physicians obligated always to act in the patient’s best interests? Journal of Medical Ethics 36(2):66–70. [PubMed] [Google Scholar]

Wicclair, M. R. 2011. Conscientious Objection in Health Care: An Ethical Analysis. Cambridge, United Kingdom: Cambridge University Press. [Google Scholar]

Widera, E. W., Rosenfeld K. E., Fromme E. K., Sulmasy D. P., and Arnold R. M.. 2011. Approaching patients and family members who hope for a miracle. Journal of Pain and Symptom Management 42(1):119–25. [PubMed] [Google Scholar]

Wildes, K. W. 1991. Institutional integrity: Approval, toleration and holy war or “always true to you in my fashion.” The Journal of Medicine and Philosophy 16(2):211–20. [PubMed] [Google Scholar]———. 1997. Institutional identity, integrity, and conscience. Kennedy Institute of Ethics Journal 7(4):413–9. [PubMed] [Google Scholar]

Woolley, S. 2005. Jehovah’s Witnesses in the emergency department: What are their rights? Emergency Medicine Journal 22(12):869–71. [PMC free article] [PubMed] [Google Scholar]Articles from The Journal of Medicine and Philosophy are provided here courtesy of Oxford University Press

Other Formats

PDF (229K)

Actions

Cite

Collections

Add to Collections

Create a new collection

Add to an existing collection

Name your collection:

Name must be less than characters

Choose a collection:

Unable to load your collection due to an error

Please try again

Add

Cancel

Permalink

Copy

RESOURCES

Similar articles

Cited by other articles

Links to NCBI Databases

[x]

Cite

Copy

Download .nbib

.nbib

Format:

AMA

APA

MLA

NLM

Follow NCBI

Twitter

Facebook

GitHub

Connect with NLM

SM-Twitter

SM-Facebook

SM-Youtube

National Library of Medicine

8600 Rockville Pike

Bethesda, MD 20894

Web Policies

FOIA

HHS Vulnerability Disclosure

Help

Accessibility

Careers

NLM

NIH

HHS

USA.gov

Just a moment...

a moment...Enable JavaScript and cookies to conti