Jeff Byrnes

In a recent issue of this journal, Gamble and Saad offer a taxonomy of conscientious objection in health care with the aim of increasing the common ground in the debate over conscientious objection to prevent parties from talking past each other and help facilitate greater progress on this issue. Although we agree that this is an important and worthwhile project, Gamble and Saad's proposal suffers from several serious weaknesses that limit its ability to do the work set out for it. In this paper, we identify some of the major problems with this particular attempt in order to highlight some desiderata for a taxonomy of conscientious objection in health care that can serve as a guide for developing improved taxonomies of this kind in the future.

In response to recent proposals to utilize artificial intelligence (AI) to automate ethics consultations in healthcare, we raise two main problems for the prospect of having healthcare professionals rely on AI-driven programs to provide ethical guidance in clinical matters. The first cause for concern is that, because these programs would effectively function like black boxes, this approach seems to preclude the kind of transparency that would allow clinical staff to explain and justify treatment decisions to patients, fellow caregivers, and those tasked with providing oversight. The other main problem is that the kind of authority that would need to be given to the guidance issuing from these programs in order to do the work set out for them would mean that clinical staff would not be empowered to provide meaningful safeguards against it in those cases when its recommendations are morally problematic.

The question of moral expertise remains largely academic until it serves as a foundation for a morally charged act or practice. Clinical ethics consultation is a complex and potentially impactful practice typifying the translation of theoretical ethics to clinical ethics, from the textbook to the bedside. To this extent, clinical ethics consultation requires a very concrete, applicable form of moral expertise. This service is no different from consulting services provided by other disciplines in health care, which have long ago instituted professional practice standards and methods for evaluating quality of care. In addition to the skills identified by the ASBH, we contend that clinical ethics consultants would benefit from a personalist approach to professionalism, that encourages the development of character traits intrinsic to a profession. In clinical ethics, we argue that this could be achieved, as other professions have discovered, through apprenticeship and professional accreditation. We show that this suggestion is consistent with statements from the ASBH as well as the UK Clinical Ethics Network.

Mark Wicclair’s defense of conscientious objection is grounded in an effort to respect the core moral beliefs of health care providers. While such a theoretical schema has merit, this paper argues that core moral beliefs should not serve as the basis of conscientious objection in health care because we, as a community, lack reliable access to a person’s core moral beliefs and because individuals are prone to be confused about the scope and extent of their core moral beliefs. Furthermore, a person’s confusion over their core moral beliefs is likely to be exacerbated when they lack time to investigate those beliefs and are under heightened external pressure to do so—both conditions frequently encountered by health care providers. Finally, the paper considers whether grounding conscientious objection in core moral beliefs might have the unintended consequence of further entrenching the practical problems that the move is aiming to solve.