Fovargue Sara, Neal Mary
Law School and Centre for Bioethics and Medical Law, Lancaster University, Lancaster LA1 4YN, UK
Law School, Strathclyde University, Glasgow, UK.
Med Law Rev. 2015 Spring;23(2):221-41. doi: 10.1093/medlaw/fwv007. Epub 2015 May 5.
Lack of clarity about the proper limits of conscientious refusal to participate in particular healthcare practices has given rise to fears that, in the absence of clear parameters, conscience-based exemptions may become increasingly widespread, leading to intolerable burdens on health professionals, patients, and institutions. Here, we identify three factors which clarify the proper scope of conscience-based exemptions: the liminal zone of 'proper medical treatment' as their territorial extent; some criteria for genuine conscientiousness; and the fact that the exercise of a valid conscience-based exemption carries certain duties with it. These restricting factors should reassure those who worry that recognising rights of conscience at all inevitably risks rampant subjectivity and self-interest on the part of professionals. At the same time, they delineate a robust conscience zone: where a claim of conscience relates to treatment with liminal status and satisfies the criteria for conscientious character, as well as the conditions for conscientious performance, it deserves muscular legal protection.
对于依良心拒斥参与特定医疗行为的合理界限缺乏明确界定，引发了人们的担忧，即在缺乏明确参数的情况下，基于良心的豁免可能会越来越普遍，给医疗专业人员、患者和机构带来难以承受的负担。在此，我们确定了三个因素，这些因素阐明了基于良心的豁免的合理范围：“适当医疗”的临界区域作为其地域范围；真正出于良心的一些标准；以及行使有效的基于良心的豁免会附带某些义务这一事实。这些限制因素应能让那些担心承认良心权利必然会导致专业人员出现猖獗的主观性和私利行为的人安心。与此同时，它们划定了一个有力的良心区域：当良心主张涉及具有临界状态的治疗，且满足出于良心的特征标准以及出于良心履行的条件时，它应得到强有力的法律保护。
