Ryan Kulesa

Some authors argue that it is permissible for clinicians to conscientiously provide abortion services because clinicians are already allowed to conscientiously refuse to provide certain services. Call this the symmetry thesis. We argue that on either of the two main understandings of the aim of the medical profession—what we will call “pathocentric” and “interest‐centric” views—conscientious refusal and conscientious provision are mutually exclusive. On pathocentric views, refusing to provide a service that takes away from a patient's health is professionally justified because there are compelling reasons, based on professional standards, to refuse to provide that service (e.g., it does not heal, and it is contrary to the goals of medicine). However, providing that same service is not professionally justified when providing that service would be contrary to the goals of medicine. Likewise, the thesis turns out false on interest‐centric views. Refusing to provide a service is not professionally justified when that service helps the patient fulfill her autonomous preferences because there are compelling reasons, based on professional standards, to provide that service (e.g., it helps her achieve her autonomous preferences, and it would be contrary to the goals of medicine to deny her that service). However, refusing to provide that same service is not professionally justified when refusing to provide that service would be contrary to the goals of medicine. As a result, on either of the two most plausible views on the goals of medicine, the symmetry thesis turns out false.

In this article, I present a novel argument against abortion. In short, what makes it wrong to kill someone is that they are a counterfactual person; counterfactual persons are individuals such that, were they not killed, they would have been persons. My view accommodates two intuitions which many views concerning the wrongness of killing fail to account for: embryo rescue cases and the impermissibility of infanticide. The view avoids embryo rescue cases because embryos in the rescue scenarios are not counterfactual people: they are not counterfactual people because it is false to say that, were they not killed, they would have been persons. As a result, it does not follow from my account that there is a prohibition against allowing embryos to die. On the other hand, infants are counterfactual people: an infant is an individual such that, were she not killed, she would have been a person.

In her paper, “The cost of conscience: Kant on conscience and conscientious objection,” Jeanette Kennett argues that a Kantian view of conscientious objection in medicine would bar physicians from refusing to perform certain practices based on conscience. I offer a response in the following manner: First, I reconstruct her main argument; second, I present a more accurate picture of Kant’s view of conscience. I conclude that, given a Kantian framework, a physician should be allowed to refuse to perform practices that break the moral law and, thus, refuse practices that violate her conscience.

That a standard of medical care must outline services that benefit the patient is relatively uncontroversial. However, one must determine how the practices outlined in a medical standard of care should benefit the patient. I will argue that practices outlined in a standard of medical care must not detract from the patient’s well-functioning and that clinicians can refuse to provide services that do. This paper, therefore, will advance the following two claims: (1) a standard of medical care must not cause dysfunction, and (2) if a physician is medically rational to not provide some service which fails to meet the above condition (i.e. fails to be a standard of medical care), then she may refuse to do so. I then apply my thesis to the prescription of puberty blockers to children with gender dysphoria.

This paper aims to outline a counterfactual theory of divine atemporal causation that avoids problems of preemption. As a result, the presentation of the analysis is structured such that my counterfactual analysis directly addresses preemption issues. If these problems can be avoided, the theist is well on her way to proposing a usable metaphysical concept of atemporal divine causation. In the first section, I outline Lewis’ original counterfactual analysis as well as how these cases of preemption cause problems for his analysis. In particular, two cases of preemption have proven problematic for counterfactual analyses: late preemption and trumping preemption. In the second section, I propose a counterfactual analysis of divine causation that is not subject to these problems of preemption. I present a counterfactual analysis of timeless divine causation, supplemented by a definition of what it means for God to allow an event to happen. In the third section, I argue this analysis is not prey to problems of preemption.