• Ethics

Steve Clarke, Nathan Emmerich, Francesca Minerva and Toni Saad have offered nuanced and insightful commentaries on my paper ‘The truth behind conscientious objection in medicine’.1 I cannot, in this brief response, do justice to all of the objections and suggestions that they have raised. I have tried to focus my response on what I take to be my interlocutors’ main concerns with my Smithian account, with the hope that we can continue the conversation elsewhere.

Clarke argues that both Smith and I ‘underestimate the difficulties involved in overcoming the distorting influence of “self-love” on moral judgement’ and ‘fail to recognise how easy it is for us to mistake a self-interested view for an impartial one’.2 His thought is that cognitive bias and ideological commitments will prevent many of us from identifying the standpoint of the impartial spectator and from realising that we are not impartial.1 I agree that successfully adopting the standpoint of the impartial spectator is not an easy task. However, moral reasoning more generally is difficult and susceptible to bias. This does not mean that we should cease such reasoning; rather, we ought to do our best, and we are, at times, successful. Clarke discusses the entrenched attitudes of Antebellum white racists. However, attitudes about slavery have changed, and cognitive biases can change too. In other words, moral progress is possible. Moreover, as I argue in the paper, one of the advantages of the impartial-spectator approach is that it ‘provides a standpoint from which shared deliberation is possible and public reasons are available’.1 Thus, we can appreciate, with relative ease, whether an objector is reasoning from this standpoint.

Clarke further argues that we should entertain the idea of employing ‘experts who are trained to overcome cognitive bias and to set aside ideological commitments’ and …