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The truth behind conscientious objection in medicine: a reply to Clarke, Emmerich, Minerva and Saad
  1. Nir Ben-Moshe
  1. Philosophy, University of Illinois at Urbana-Champaign, Urbana, IL 61801, USA
  1. Correspondence to Professor Nir Ben-Moshe, Philosophy, University of Illinois at Urbana-Champaign, Urbana, IL 61801, USA; NIR{at}ILLINOIS.EDU

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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 …

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Footnotes

  • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

  • Competing interests None declared.

  • Patient consent for publication Not required.

  • Provenance and peer review Commissioned; internally peer reviewed.

  • iClarke rightly notes that Smith was sensitive to the fact that we might not always be successful in adopting the standpoint of the impartial spectator.2 In addition to the passage that he discusses, see, for example, TMS I.i.5.8.4

  • iiEmmerich develops the claim that ‘the instantiation of a CO should be perceived as a sociopolitical device for the resolution of (certain) good faith moral disagreements in particular social, cultural and historical contexts’.3 While I cannot discuss all the factes of that claim in this brief response, it is worth noting that Smith’s impartial spectator is, to a certain extent, sensitive to pertinent social, cultural and historical contexts. See Part V of TMS and Samuel Fleischacker’s ‘Adam Smith and cultural relativism’.4 8

  • iiiThe ‘in principle’ qualification is important: it might not always be possible for the conscientious objector to do much to reform prevailing norms. Thus, while the German physician should, in principle, attempt to reform the prevailing norms, there might be little that he can do (apart from refusing to conduct the experiments in question).

  • ivThere is much more to be said about Smith’s account and I develop aspects of it elsewhere.9 10 See also footnote ii.

  • vSaad concludes by offering a sketch of a different account of conscience based in part on Thomas Aquinas’s thought.7 While his suggestion is interesting, I cannot discuss its many merits and problems in this brief response.

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