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The truth behind conscientious objection in medicine: a reply to Clarke, Emmerich, Minerva and Saad

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  • 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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