Department of Philosophy, University of Illinois at Urbana-Champaign, 200 Gregory Hall, 810 South Wright Street, Urbana, IL, 61801, USA.
HEC Forum. 2021 Sep;33(3):269-289. doi: 10.1007/s10730-020-09401-z.
The literature on conscientious objection in medicine presents two key problems that remain unresolved: (a) Which conscientious objections in medicine are justified, if it is not feasible for individual medical practitioners to conclusively demonstrate the genuineness or reasonableness of their objections ("the justification problem")? (b) How does one respect both medical practitioners' claims of conscience and patients' interests, without leaving practitioners complicit in perceived or actual wrongdoing ("the complicity problem")? My aim in this paper is to offer a new framework for conscientious objections in medicine, which, by bringing medical professionals' conscientious objection into the public realm, solves the justification and complicity problems. In particular, I will argue that: (a) an "Uber Conscientious Objection in Medicine Committee" ("UCOM Committee")-which includes representatives from the medical community and from other professions, as well as from various religions and from the patient population-should assess various well-known conscientious objections in medicine in terms of public reason and decide which conscientious objections should be permitted, without hearing out individual conscientious objectors; (b) medical practitioners should advertise their (UCOM Committee preapproved) conscientious objections, ahead of time, in an online database that would be easily accessible to the public, without being required, in most cases, to refer patients to non-objecting practitioners.
（a）如果个别医务人员无法最终证明其反对意见的真实性或合理性，那么医学中的哪些良心拒绝是合理的（“正当性问题”）？（b）如何在不使医务人员陷入被认为或实际的不当行为的共谋之中的情况下，同时尊重医务人员的良心主张和患者的利益（“共谋问题”）？我在本文中的目的是为医学中的良心拒绝提供一个新的框架，通过将医务人员的良心拒绝纳入公共领域，解决正当性和共谋问题。具体而言，我将主张：（a）一个“医学上的超级良心拒绝委员会”（“UCOM 委员会”）——包括来自医疗界和其他专业领域的代表，以及来自各种宗教和患者群体的代表——应该根据公共理性来评估医学中的各种著名良心拒绝，并决定应该允许哪些良心拒绝，而无需听取个别良心拒绝者的意见；（b）医务人员应该提前在一个在线数据库中宣传他们（UCOM 委员会预先批准的）良心拒绝，该数据库对公众来说很容易访问，在大多数情况下，无需将患者转介给不持反对意见的从业者。
