Tolerance, Professional Judgment, and the Discretionary Space of the Physician
Tolerance, Professional Judgment, and the Discretionary Space of the Physician
复制标题
DOI：
10.1017/s0963180116000621
复制
发表时间：
2017-01-01
影响因子：
1.8
通讯作者：
Sulmasy, Daniel P.
中科院分区：
文献类型：
--
作者：
Sulmasy, Daniel P.
反对医生基于良心拒服兵役而声称有权拒绝向病人提供检测或治疗的论点往往基于两个很少明确说明的前提。第一，对宗教自由的保护(广义解释)应限于礼拜、集会和信仰自由。第二，由于职业是由国家许可的，任何从事许可职业的公民都必须提供由该职业确定的、属于该专业的执业范围并经国家允许的所有商品和服务，而不考虑任何个人的宗教、哲学或道德异议。在这篇文章中，我认为这些前提应该被拒绝，因此依赖于它们的论点也应该被拒绝。第一个前提与洛克的宽容概念是不相容的，后者承认基本的、自我认同的信念影响公共和私人行为，应该得到广泛的宽容。第二个前提不适当地(而且不切实际地)缩小了专业实践的自由裁量权空间，从而破坏了专业应该被允许为公共利益做出贡献的程度。然而，在职业实践的公共领域，对依良心拒服兵役的容忍度不应是无限的，文章提出了几种常识，即对医生依良心拒服兵役的主张的容忍度限制。
Arguments against physicians' claims of a right to refuse to provide tests or treatments to patients based on conscientious objection often depend on two premises that are rarely made explicit. The first is that the protection of religious liberty (broadly construed) should be limited to freedom of worship, assembly, and belief. The second is that because professions are licensed by the state, any citizen who practices a licensed profession is required to provide all the goods and services determined by the profession to fall within the scope of practice of that professional specialty and permitted by the state, regardless of any personal religious, philosophical, or moral objection. In this article, I argue that these premises ought to be rejected, and therefore the arguments that depend on them ought also to be rejected. The first premise is incompatible with Locke's conception of tolerance, which recognizes that fundamental, self-identifying beliefs affect public as well as private acts and deserve a broad measure of tolerance. The second premise unduly (and unrealistically) narrows the discretionary space of professional practice to an extent that undermines the contributions professions ought to be permitted to make to the common good. Tolerance for conscientious objection in the public sphere of professional practice should not be unlimited, however, and the article proposes several commonsense, Lockean limits to tolerance for physician claims of conscientious objection.