Alberto Giubilini

The Paradox of Conscientious Objection and the Anemic Concept of 'Conscience': Downplaying the Role of Moral Integrity in Health Care

Conscientious objection in health care is a form of compromise whereby health care practitioners can refuse to take part in safe, legal, and beneficial medical procedures to which they have a moral opposition (for instance abortion). Arguments in defense of conscientious objection in medicine are usually based on the value of respect for the moral integrity of practitioners. I will show that philosophical arguments in defense of conscientious objection based on respect for such moral integrity are extremely weak and, if taken seriously, lead to consequences that we would not (and should not) accept. I then propose that the best philosophical argument that defenders of conscientious objection in medicine can consistently deploy is one that appeals to (some form of) either moral relativism or subjectivism. I suggest that, unless either moral relativism or subjectivism is a valid theory—which is exactly what many defenders of conscientious objection (as well as many others) do not think—the role of moral integrity and conscientious objection in health care should be significantly downplayed and left out of the range of ethically relevant considerations.

Abortion and the Argument from Potential: What We Owe to the Ones Who Might Exist

I challenge the idea that the argument from potential (AFP) represents a valid moral objection to abortion. I consider the form of AFP that was defended by Hare, which holds that abortion is against the interests of the potential person who is prevented from existing. My reply is that AFP, though not unsound by itself, does not apply to the issue of abortion. The reason is that AFP only works in the cases of so-called same number and same people choices, but it falsely presupposes that abortion is such a kind of choice. This refutation of AFP implies that (1) abortion is not only morally permissible but sometimes even morally mandatory and (2) abortion is morally permissible even when the potential persons life is foreseen to be worth living.

What in the World Is Moral Disgust

I argue that much philosophical discussion of moral disgust suffers from two ambiguities: first, it is not clear whether arguments for the moral authority of disgust apply to disgust as a consequence of moral evaluations or instead to disgust as a moralizing emotion; second, it is not clear whether the word ‘moral’ is used in a normative or in a descriptive sense. This lack of clarity generates confusion between ‘fittingness’ and ‘appropriateness’ of disgust. I formulate three conditions that arguments for the moral authority of disgust need—but typically fail—to satisfy, in order to avoid (1) circularity, (2) the naturalistic fallacy, and (3) redundancy. These conditions are, respectively, (1) the identification of the direction of the causal relation between disgust and moral evaluation, (2) a demonstration that disgust is ‘fitting’ to morally relevant properties, and (3) a demonstration that disgust is ‘appropriate’ when elicited by these morally relevant properties. I will also suggest that, regardless of whether an argument for the moral authority of disgust can be made, it would be better to avoid the rather obscure term ‘moral disgust’.

Conscientious Objection to Vaccination

ABSTRACT Vaccine refusal occurs for a variety of reasons. In this article we examine vaccine refusals that are made on conscientious grounds; that is, for religious, moral, or philosophical reasons. We focus on two questions: first, whether people should be entitled to conscientiously object to vaccination against contagious diseases (either for themselves or for their children); second, if so, to what constraints or requirements should conscientious objection (CO) to vaccination be subject. To address these questions, we consider an analogy between CO to vaccination and CO to military service. We argue that conscientious objectors to vaccination should make an appropriate contribution to society in lieu of being vaccinated. The contribution to be made will depend on the severity of the relevant disease(s), its morbidity, and also the likelihood that vaccine refusal will lead to harm. In particular, the contribution required will depend on whether the rate of CO in a given population threatens herd immunity to the disease in question: for severe or highly contagious diseases, if the population rate of CO becomes high enough to threaten herd immunity, the requirements for CO could become so onerous that CO, though in principle permissible, would be de facto impermissible.

Clarifications on the moral status of newborns and the normative implications

In this paper we clarify some issues related to our previous article ‘After-birth abortion: why should the baby live?’.

Conscientious objection and medical tribunals

Professionals have a prima facie obligation to do what their profession requires. This is an uncontroversial principle. Equally uncontroversial is that our conscience is essential to our moral integrity. On any account of conscience (whether religious, philosophical or psychological), conscience encompasses core and self-identifying moral beliefs.1 ,2 Therefore, there is also a prima facie duty to respect conscience. The issue of conscientious objection in healthcare is the issue of whether and how to strike a balance between these two prima facie duties when they conflict with each other, for example, when doctors have a conscientious objection to abortion. One problem is that sometimes objection to abortion is not genuinely conscientious. For example, in Italy some doctors who are formally conscientious objectors in public hospitals perform illegal abortions in private clinics.3 Unfortunately, it is extremely difficult to pick out such cases. We might introduce ‘medical tribunals’ that assess the genuineness of conscientious objection. According to Christopher Cowley,4 however, such tribunals would be useless, because nothing could constitute evidence for genuineness. For example, Cowley says that the fact that a doctor behaves like a good Catholic in her private life (eg, she goes to Church every Sunday) is no evidence that her objection to abortion is genuinely based on religious conscience. I agree with Cowley on this point, but not for the same reasons he offers. Cowleys reason is …

Don't mind the gap: intuitions, emotions, and reasons in the enhancement debate

Reliance on intuitive and emotive responses is widespread across many areas of bioethics. The current debate on biotechnological human enhancement is particularly interesting in this respect. A strand of “bioconservatives” that has explicitly drawn connections to the modern conservative tradition, dating back to Edmund Burke, appeals to the alleged wisdom of our intuitions and emotions to ground opposition to some biotechnologies or their uses. Such reliance on intuitions and emotions is widely acknowledged as one of the distinguishing features of this conservative strand by both its supporters and opponents. So-called bioliberals, those who in principle do not oppose human bioenhancement, tend to rely on rational arguments and to see intuitions and emotions mostly as sources of biases. This approach often translates into shifting the burden of proof onto bioconservatives and challenging them to provide arguments against the proposed enhancement to back what bioliberals perceive as merely intuitive, emotive, and irrational reactions. In this article, I am going to show that the methodological divide between bioliberals and bioconservatives is less significant than at first glance it appears to be and less significant than it is often taken to be. I will do so by defending two theses. The first is that reliance on intuitions and emotions is not a prerogative of bioconservatives: bioliberals have their typical intuitions and emotive responses and are for this reason exposed to potential biases in the same way as bioconservatives are. The second thesis is that reliance on intuitions and emotions is not necessarily antithetic to reason and rationality.

Why and How to Compensate Living Organ Donors: Ethical Implications of the New Australian Scheme

The Australian Federal Government has announced a two-year trial scheme to compensate living organ donors. The compensation will be the equivalent of six weeks paid leave at the rate of the national minimum wage. In this article I analyse the ethics of compensating living organ donors taking the Australian scheme as a reference point. Considering the long waiting lists for organ transplantations and the related costs on the healthcare system of treating patients waiting for an organ, the 1.3 million AUD the Australian Government has committed might represent a very worthwhile investment. I argue that a scheme like the Australian one is sufficiently well designed to avoid all the ethical problems traditionally associated with attaching a monetary value to the human body or to parts of it, namely commodification, inducement, exploitation, and equality issues. Therefore, I suggest that the Australian scheme, if cost-effective, should represent a model for other countries to follow. Nonetheless, although I endorse this scheme, I will also argue that this kind of scheme raises issues of justice in regard to the distribution of organs. Thus, I propose that other policies would be needed to supplement the scheme in order to guarantee not only a higher number of organs available, but also a fair distribution.

The Artificial Moral Advisor. The “Ideal Observer” Meets Artificial Intelligence

We describe a form of moral artificial intelligence that could be used to improve human moral decision-making. We call it the “artificial moral advisor” (AMA). The AMA would implement a quasi-relativistic version of the “ideal observer” famously described by Roderick Firth. We describe similarities and differences between the AMA and Firth’s ideal observer. Like Firth’s ideal observer, the AMA is disinterested, dispassionate, and consistent in its judgments. Unlike Firth’s observer, the AMA is non-absolutist, because it would take into account the human agent’s own principles and values. We argue that the AMA would respect and indeed enhance individuals’ moral autonomy, help individuals achieve wide and a narrow reflective equilibrium, make up for the limitations of human moral psychology in a way that takes conservatives’ objections to human bioenhancement seriously, and implement the positive functions of intuitions and emotions in human morality without their downsides, such as biases and prejudices.

Harms to Vendors: We Should Discourage, Not Prohibit Organ Sales

Selling a kidney is probably a poor decision. Julian Koplins (2014) review of the medical and anthropological literature indicates that “vendors will usually experience a range of significant harm...