Wicclair Mark R
Perspect Biol Med. 2019;62(3):543-559. doi: 10.1353/pbm.2019.0032.
Lauris Kaldjian defends conscientious objection against opponents who claim that there is no place for a physician's personal moral beliefs in the practice of medicine. This essay argues that Kaldjian's defense of conscientious objection relies on a controversial "thick" conception of conscience that opponents may justifiably question. It offers a defense that relies on a relatively "thin" conception of conscience as an agent's core moral beliefs and that understands conscience-based refusals to provide medical services as refusals based on those core beliefs. Enabling physicians to practice medicine without compromising their moral integrity is an important pro tanto reason to accommodate physicians who conscientiously object to providing medical services. However, giving due consideration to the professional obligations of physicians requires constraints on accommodation. Accommodation should not: (1) impede a patient's timely access to relevant information; (2) impede a patient's timely access to referral and counselling; (3) impede a patient's timely access to medical services that are consistent with prevailing professional standards; (4) enable physicians to practice invidious discrimination; (5) place an excessive burden on other health professionals and institutions; or (6) authorize physicians to unilaterally decide to forgo life-sustaining treatment against the wishes of patients or surrogates.
劳里斯·卡尔德jian为依良心拒行辩护，反对那些声称医生个人道德信念在医疗实践中无立足之地的反对者。本文认为，卡尔德jian对依良心拒行的辩护依赖于一种有争议的“厚实”良心概念，反对者可能有理由对此提出质疑。本文提供了一种辩护，它依赖于一种相对“单薄”的良心概念，即作为行为主体核心道德信念的良心，并将基于良心拒绝提供医疗服务理解为基于这些核心信念的拒绝。使医生能够在不损害其道德完整性的情况下行医，是接纳依良心拒行提供医疗服务的医生的一个重要的初步理由。然而，充分考虑医生的职业义务需要对接纳加以限制。接纳不应：(1) 妨碍患者及时获取相关信息；(2) 妨碍患者及时获得转诊和咨询；(3) 妨碍患者及时获得符合现行专业标准的医疗服务；(4) 使医生能够进行恶意歧视；(5) 给其他医护人员和机构带来过重负担；或(6) 授权医生违背患者或代理人的意愿单方面决定放弃维持生命的治疗。
