Trust me: I'll act against my conscience

The title throws you for a loop, doesn't it?

Trust me to do what? Follow the law, when I can violate my own conscience? Practice ethical medicine when I promise not to have any personal convictions to guide me? What are laws and ethics to a person who has no conscience?

This month's American Journal of Bioethics - unfortunately available only by subscription - is devoted to exploring the conscientious objection of pharmacists (and by extension, doctors and nurses, and everyone of us) who refuse to dispense emergency contraception (EC).

I do not believe that there is any evidence that the progesterone-only EC, Plan B, has abortifacient post-fertilization effects. In other words, I believe that anyone who objects to Plan B on the grounds that it causes the loss of a human life is mistaken.

However, I don't believe that they should be forced to perform acts that go against their consciences or subjected to a special conscientious objector review board, as advocated by all but one of the "open peer commentary" on the "Target Article" by Robert F. Card, (Abstract here), "Conscientious Objection and Emergency Contraception."

Card obviously has a bias against those of us who believe that human life begins at fertilization and that all humans have the right not to be killed. Nevertheless, as one commenter, Farr Curlin, MD, notes (It's worth reading all this, trust me):

Card (2007) does not merely claim that practitioners are obligated to provide EC; he argues that they are obligated to do so even if they have a conscientious objection. This last clause may seem harmless on the surface, but a closer look reveals that it effectively saws off the limb on which the first clause and all medical ethics sit. To begin, what is a conscientious objection, but an individual’s judgment that it would be unethical for him or her to act in a certain way? A genuine conscientious objection, even if misinformed, is an expression of a commitment to acting morally, and although religious persons are somewhat more likely to report conscientious objections (Curlin et al. 2007), judgments of conscience need not be informed by explicitly religious ideas. Moreover, all ethical arguments are appeals to conscience. As such, acting conscientiously is the most fundamental of all moral obligations.

....


Indeed, the very act of presenting evidence and making arguments presumes that the one to whom those arguments are directed, whether practitioner or juror, is committed to acting according to their best judgment after taking all relevant considerations into account. It would be useless for an attorney to make arguments to jurors if those jurors were not committed to deciding a verdict based on their best judgment of the guilt or innocence of the defendant. Likewise, it is useless for Card or anyone else to make ethical arguments if practitioners are not committed to practicing according to their best judgment of what is in fact ethical. A commitment to acting conscientiously is as fundamental to the moral life as a commitment to judging impartially is to the work of a
juror.