Monday, April 13, 2009

"Conscience vs. Conscience"


Stanley Fish has an interesting piece in The New York Times today. In the final days of the Bush administration a regulation was put in place that allows health care providers to refuse to provide health services that would violate their consciences. One presumes that the intent of the conservative administration was to allow physicians to refuse to perform abortions or other contraceptive services. (Recall in the past that blacks died because they were refused services in "whites only" emergency rooms; would we really want to allow physicians to return to such practices on the claim that giving service to a people of a racial group would "violate their consciences"?) I hope, along with many others that the Obama administration will undo the regulation, providing more appropriate guidance to medical practioners.

Fish notes that Hobbs defined "conscience", based on its etiology, to be the following of socially agreed upon norms rather that listening to "one's inner voice" of conscience. In that definition, the problem goes away. The law and the regulations interpreting the law define the social consensus as to what is right, and the publicly licensed practitioners and facilities (especially those depending on public funds) would be required to provide the services for which they are licensed and for which resources are available.

It occurs to me that scientific understanding has advanced since Thomas Hobbs lived in the 17th century. It now seems likely that as humans evolved as social animals, there are some "hard wired" aspects of morality based in our genetic heritage. These may include some orientation towards fairness with others within our social groups as well as some orientation towards altruism towards family members.

It also seems clear that some aspects of morality are cultural. The definition of "us versus them" has clearly changed to include our larger communities and nations rather than simply our tribes.

I don't see how we could have evolved hard wired feelings towards abortion and contraception since these have become practicable technical alternatives only in the last couple of generations. Moreover, the social evolution of ethical concepts about reproductive biology is readily apparent.

I suspect we should leave room for adaptation of our regulations to our evolving scientific understanding of the biological and cultural roots of morality. I also suspect that we should recognize that there are different neural bases for attitudes towards abortion than towards contraception.

I suspect as a result that public policy should focus in some areas on aculturation of health care providers to accept commonly agreed upon standards for services, and in other cases should tend to accept that some moral attitudes of provides are scarcely malleable, and in these respects individual conscience may best be respected.

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